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目的根据移植肾血管和肾小球病变的特征,研究不同类型慢性移植肾肾病(CAN)的临床表现、危险因素及其与预后的关系。方法选择肾活检证实CAN的病人100例,其中移植肾动脉病变47例(A组),移植肾肾小球病变26例(B组),单纯移植肾间质纤维化27例(C组)。比较各组患者的临床表现、危险因素、半定量组织学损害指数(CADI)和移植肾存活率。结果B组移植前有高血压病史的占26.9%,而A组和C组分别占6.4%和3.7%(P<0.05)。B组移植后CAN的诊断时间明显晚于A组和C组(P<0.001),其病理学损害分数和血压最高(P<0.05),移植肾存活率最低;CAN病人根据CADI分组后,存活率明显不同(P<0.001)。结论CAN的不同病理特征可能提示不同的危险因素和预后。
Objective To study the clinical manifestations, risk factors and their relationship with prognosis of different types of chronic allograft nephropathy (CAN) according to the characteristics of renal allograft and glomerular lesions. Methods 100 patients with CAN confirmed by renal biopsy were enrolled in this study. Among them, 47 cases were renal artery disease (group A), 26 cases were renal glomerular disease (group B) and 27 cases were renal allograft fibrosis (group C). The clinical manifestations, risk factors, semi-quantitative histological damage index (CADI) and graft survival rate were compared between groups. Results Group B had a history of hypertension of 26.9% before transplantation, while group A and C accounted for 6.4% and 3.7% respectively (P <0.05). The diagnosis time of CAN in group B was significantly later than that in group A and group C (P <0.001), and the histopathological damage score and blood pressure were the highest (P <0.05). The survival rate of transplanted kidney was the lowest. The rates were significantly different (P <0.001). Conclusion Different pathological features of CAN may indicate different risk factors and prognosis.