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目的 探讨移植肾临界改变的演变过程及其对肾移植长期效果的影响。方法 肾移植术后常规进行肾活检。对 46例首次病理确诊为”临界改变” ,临床上伴有或不伴有移植肾功能异常者进行长期随访。结果 46例临界改变多发生于术后 3个月内 (4 2例 ,占 91.3 % )。 15例临界改变伴肾功能异常者经甲泼尼龙冲击强化治疗后 ,12例于治疗后 1个月 ,血肌酐降至正常。临界改变治疗组 3年移植肾存活率明显高于对照组和临界改变未治疗组。结论 临界改变的强化治疗有利于移植肾的长期存活。
Objective To investigate the evolution of critical changes in renal transplantation and its effect on long-term renal transplantation. Methods Renal biopsy was performed routinely after renal transplantation. Forty-six patients with first-time pathological diagnosis of “critical change” were followed up for a long time with or without renal dysfunction clinically. Results 46 cases of critical changes occurred more than 3 months after operation (42 cases, 91.3%). Fifteen patients with critical changes and renal dysfunction were treated with methylprednisolone and 12 patients were treated with methylprednisolone. The serum creatinine was reduced to normal one month after treatment. The 3-year graft survival rate in the critical treatment group was significantly higher than that in the control group and in the non-critical treatment group. Conclusions Intensive treatment of critical changes is beneficial to the long-term survival of renal allografts.