摘要
目的探讨血浆置换治疗移植肾复发性局灶性节段性肾小球硬化(FSGS)效果及其对远期预后的影响。方法6例患者首次肾移植后出现大量蛋白尿或/和血肌酐(Cr)升高、并经移植肾活检确诊为FSGS,在不改变免疫抑制方案的情况下,采用血浆置换治疗,观察血浆置换后1年移植肾的病理改变情况,测定血肌酐和24 h尿蛋白定量。结果6例患者中,2例在血浆置换后1年接近完全缓解,4例部分缓解。患者血浆置换后1年,移植肾的肾小球、肾间质、血管及免疫球蛋白病变的等级与血浆置换前相比,差异均无统计学意义。血浆置换后1年及5年的Cr水平与血浆置换前相比,差异均无统计学意义;24 h尿蛋白定量与血浆置换前相比,差异均有统计学意义(P<0.01,P<0.05)。结论血浆置换能快速、有效地缓解移植肾复发性FSGS的病变程度和进程,其效果取决于FSGS诊断的及时性,如果已发展到肾小球硬化的程度,血浆置换亦无法将其逆转。
Objective To investigate the efficacy of plasma exchange （PE） in the treatment of recurrent focal segmental glomerulosclerosis （FSGS） and its effect on the long-term graft survival of renal transplant. Methods From 1990 to 2000,6 patients with recurrent FSGS proven by graft biopsy were treated with PE respectively from 3 to 9 （5 % albumin, 1.5 plasma volumes） sessions,with signal angiotensin-converting enzyme （ACE） inhibitors （Benazepril hydrochloride,30 mg/day） and without changes of immunosuppressive agents. All patients were followed for up to 5 years, including serum creatitine （SCr）, proteinuria （Pr）, re-biopsy at 1 year after PE, and graft function at 5th year. Results Two patients had complete remission and 4 cases had partial remission. Pr had a significant reduction from 4. 60 ±2. 80 g/day to 1.96 ±2. 10 g/day one year post-pheresis （P〈0. 01）, and decreased to 1.10 ±0. 80 g/day at 5th year （P〈0. 05）. SCr was slightly increased from 164 ±38μmol/L up to 184 ±90μmol/L at first year （P〉0. 05） and up to 264 ±186μmol/L at 5th year （P〉0. 05）. Four out of 6 patients kept their renal graft till 5 years with nearly normal function, one was in ESRD without hemodialysis and one had the graft removed. Graft re-biopsy showed that glomeruli lesion of FSGS at one year was not deteriorated （P〉0. 05）. Conclusions PE is an effective form of treatment for recurrent FSGS by removing circulating factor, especially if initiated early. Failure to achieve remissions and maintain stable remission after the initial period of PE imply a poor outcome and glomeruli lesion been sclerosis. Therefore,PE should be performed as early as possible until completely remissions.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第3期170-172,共3页
Chinese Journal of Organ Transplantation
关键词
肾移植
肾小球硬化症
病灶性
血浆置换
Kidney transplantation
Glomerulosclerosis, focal
Plasma exchange
