慢性排斥治疗的经验与体会

The experience of chronic renal allograft rejection treatment

为探讨慢性排斥的治疗方法对５９例肾移植术后发生慢性排斥反应患者的治疗情况进行总结。治疗包括调整原免疫抑制方案、加用甲泼尼龙、环磷酰胺、单克隆及多克隆抗体、雷公藤、百令胶囊、尿毒清等，结果１１例的肾功能得以恢复或稳定。认为：（１）急性排斥反应是慢性排斥反应发生的基础；（２）免疫过程参与慢性排斥的进展，抗排斥治疗及调整免疫抑制用药剂量可使部分慢性排斥患者得以挽救；（３）雷公藤、百令胶囊对慢性排斥有一定疗效；（４）慢性排斥患者中，淋巴细胞毒性低者肾功能得到控制的可能性更大；（５）长期免疫抑制不足是慢性排斥发生的重要原因，按时按量服药是降低慢性排斥发生率的重要环节。

To investigate the treatment of chronic rejection, 59 cases of chronic rejection (CR) following renal allograft were clinically summarized. The involved therapies included the regulation of immunosuppression with addition of CsA, monoclone antibody, multiclone antibody, Triptergium Willfordii or corbin capsule etc., then the 11 cases revealed the recovery of renal function. It was considered that: (1) Acute rejection was the basis of CR; (2) Immunological process took part in the proceeding of CR; antirejection treatment and adjustment of doses of immunosuppressive drugs might rescue partial CR patients; (3) Triptergium Willfordii and corbin capsule had some effcets on CR; (4) Of CR patients, those having lower lymphotoxicity before operation had greater possibility in the controlling of renal function disorders; (5) Long term immunosuppressive insufficiency was an important cause of CR and administration of sufficient doses of immunosuppressive drugs on time was a link to reduce the rate of CR.