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目的 :了解移植后慢性肾损害的病理类型及可能诱发的原因。 方法 :回顾分析解放军肾脏病研究所 1985年 3月至 1999年 6月因移植后慢性肾脏损害行肾活检的 97例肾移植患者。 结果 :移植后慢性肾脏损害的病理类型以慢性排斥 (慢排 )最多 77例 (79 4% ) ,系膜病变 11例 (11 3% ) ,新月体肾炎 3例 (3 1% ) ,膜性肾病2例 (2 1% ) ,IgA肾病 2例 (2 1% ) ,溶血性尿毒综合征 2例 (2 1% )。高血压的发生率为 71 1% ,蛋白尿 6 8 0 % ,镜下血尿占 15 5 % ;78 3%的患者肾功能减退。对比慢排与非慢排组患者的临床表现和实验室检查结果 ,发现二组在供肾年龄 (分别为 33 4± 6 2岁和 2 6 8± 5 3岁 ) ,急性排斥 (急排 )发生率 (46 7%和 2 7 2 % ) ,移植肾功能延迟恢复 (DGF)发生率 (16 9%和 6 0 % ) ,肾外结核感染率 (5 41%和 1 6 3% )及高血压发生率 (70 1%和 6 1 4% )均有显著性差异 (P <0 0 1) ,蛋白尿 (83 1%和 13 9% )及肾组织巨细胞病毒 (CMV)感染阳性率 (13 0 9%和 1 36 % )差异极显著 (P <0 0 0 1)。 结论 :移植后慢性肾脏损害最常见的病理类型仍为慢排。与慢排相关的因素可能包括 :供肾年龄 ,急排发生率 ,DGF及CMV感染。高血压和蛋白尿对移植肾的远期预后也有重要影响。
Objective: To understand the pathological types of chronic kidney injury after transplantation and possible causes. Methods: A retrospective analysis of the PLA Renal Disease Institute from March 1985 to June 1999 due to chronic kidney damage after kidney biopsy in 97 cases of renal transplant patients. RESULTS: The pathological types of chronic kidney injury after transplantation were as follows: chronic rejection (up to 77) (79.4%), mesangial lesions (11.3%), crescentic nephritis in 3 (31%), 2 cases of nephropathy (21%), 2 cases of IgA nephropathy (21%) and 2 cases of hemolytic uremic syndrome (21%). The incidence of hypertension was 71.1%, proteinuria was 68.0%, microscopic hematuria accounted for 15.5%; 78.3% of patients with renal dysfunction. Comparing the clinical manifestations and laboratory findings in patients with chronic and non-chronic rejection groups, we found that there were no significant differences between the two groups in terms of renal age (33 4 ± 6 2 and 26 8 ± 5 3 years old, respectively), acute rejection The incidence of delayed renal transplant (DGF) (16 9% and 60%), extranodal tuberculosis infection (41 41% and 163%) and high The incidence of blood pressure (70 1% and 61 4%) were significantly different (P 0 01), proteinuria (83 1% and 13 9%) and renal tissue cytomegalovirus (CMV) 13 0 9% and 1 36%) were significantly different (P 0 01). CONCLUSIONS: The most common pathological type of chronic kidney damage after transplantation is still chronic plaque. Factors related to the slow row may include: age of the kidney, incidence of emergency plaque, infection with DGF and CMV. Hypertension and proteinuria also have a major impact on the long-term prognosis of transplant recipients.