【摘要】：目的:回顧性分析抗中性粒細(xì)胞胞質(zhì)抗體(ANCA)相關(guān)腎炎(AAGN)患者接受腎移植后的轉(zhuǎn)歸。方法:11例AAGN患者[男4例,女7例,中位年齡48(33.5~52.5)歲]接受腎移植。采用激素、嗎替麥考酚酯聯(lián)合他克莫司/環(huán)孢素A三聯(lián)抗排斥治療。腎移植后排斥反應(yīng)及其類型均經(jīng)移植腎活檢病理診斷�；仡櫺苑治鲆浦材I預(yù)后、血管炎復(fù)發(fā)及血清ANCA對(duì)移植腎預(yù)后的影響。結(jié)果:11例AAGN均為MPO-ANCA相關(guān)血管炎,10例在腎移植前接受腎臟替代治療,中位時(shí)間為30.5(14.8~50.5)個(gè)月。腎移植前均無血管炎活動(dòng)(BVAS 0分),7例血清MPO-ANCA陽性。腎移植術(shù)后均未出現(xiàn)移植腎功能延遲恢復(fù),4例(36.4%)發(fā)生急性細(xì)胞性排斥反應(yīng),分別有1例術(shù)后18個(gè)月和22個(gè)月發(fā)生血管炎復(fù)發(fā)和慢性體液性排斥反應(yīng)。術(shù)后中位隨訪56(46.5~135)個(gè)月,隨訪末8例(72.7%)血清肌酐水平正常,2例血清肌酐升高,1例移植腎失功。5年人、腎生存率分別為100%和90.9%。術(shù)前ANCA陽性與陰性患者比較移植腎排斥反應(yīng)發(fā)生率和血管炎復(fù)發(fā)率均無顯著差異。結(jié)論:AAGN患者腎臟移植后遠(yuǎn)期預(yù)后好,血管炎復(fù)發(fā)率低,但術(shù)后早期急性排斥反應(yīng)發(fā)生率高,應(yīng)加強(qiáng)預(yù)防抗排斥反應(yīng)。
[Abstract]:Aim: to retrospectively analyze the outcome of renal transplantation in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN). Methods: renal transplantation was performed in 11 patients with AAGN [4 males and 7 females with a median age of 48 (33.5 鹵52.5) years]. Steroids, metocophenolate mofetil and tacrolimus / cyclosporine A combined anti-rejection therapy were used. The rejection and its types after renal transplantation were all diagnosed by biopsy. The prognosis, recurrence of vasculitis and serum ANCA were analyzed retrospectively. Results: 11 cases of AAGN were MPO-ANCA associated vasculitis, 10 cases received renal replacement therapy before renal transplantation, the median time was 30.5 (14.8 鹵50.5) months. There was no vasculitis activity (BVAS 0) before renal transplantation, and 7 cases were positive for serum MPO-ANCA. 4 cases (36.4%) developed acute cellular rejection, and 1 case developed recurrent vasculitis and chronic humoral rejection at 18 months and 22 months, respectively. The median follow-up was 56 months (46.5 鹵135 months). At the end of follow-up, the serum creatinine levels were normal in 8 cases (72.7%), elevated in 2 cases, and dysfunction in 1 case. The renal survival rate was 100% and 90.9% in 5 year patients, respectively. There was no significant difference in the incidence of graft rejection and the recurrence rate of vasculitis between ANCA positive and negative patients before operation. Conclusion: the long term prognosis and recurrence rate of vasculitis in AAGN patients are good, but the incidence of early acute rejection is high. The prevention of anti rejection should be strengthened.
【作者單位】： 南京總醫(yī)院腎臟科國家腎臟疾病臨床醫(yī)學(xué)研究中心全軍腎臟病研究所;
【基金】：國家臨床重點(diǎn)�？栖婈�(duì)建設(shè)項(xiàng)目腎臟科專項(xiàng)(2014ZDZK001) 國家科技支撐計(jì)劃課題(2015BAI12B05,2015BAI12B02)
【分類號(hào)】：R699.2

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