慢性排斥反应的病因与病理学分析

Chronic cadaveric renal allograft rejection

为探讨慢性排斥（ＣＲ）的病因与病理学，对１１４１例尸肾移植者中５９例接受治疗的ＣＲ病例进行回顾分析。结果：（１）ＣＲ占总病例的５．２％，平均发生于术后２３个月，有急性排斥（ＡＲ）史者２７．１％，免疫抑制药物服用不足者２５．４％，余为不明原因者。免疫抑制不足者中患者擅自减少剂量者７３．３％，经抗排斥治疗及增加药物剂量后肾功正常或稳定者占１８．６％。（２）ＣＲ表现为间质纤维增殖、小淋巴细胞和浆细胞散在浸润；肾小球基底膜增厚，透明样变，血管内膜增厚。结论：（１）ＡＲ是ＣＲ发生的基础；（２）抗排斥与调整免疫抑制药量可挽救部分ＣＲ；（３）雷公藤、百令胶囊治疗ＣＲ有一定疗效；（４）ＣＲ患者中，淋巴细胞毒性低者肾功能更可能得到控制；（５）长期免疫抑制不足是ＣＲ发生的重要原因，按时按量服药可降低ＣＲ发生率。

Among 1 141 cadaveric renal allografts,chronic rejection occurred in 59 (5.2%).CR occurred usually 23 months after transplantation and the morbidity of past acute rejection episodes was 27.1%(16/59).In 15,insufficient immunosuppressives seemed to be the cause of CR due to reduction of the dosage by the patient himself.On antirejection treatment and increase of the immunosuppressives and/or triptergium willfordii and corbin capsules,graft function recovered in 5 cases and the serum creatinine has been stabilized without further rising in 6 while all the others progressed to uremia.The main pathological manifestations of CR was interstitial fiber proliferation and scattered infiltration of small lymphocytes and plasmocytes with basement membrane thickening,hyalinosis and vasular intima thickening of glomeruli.It was claimed that CR was an important predisposing factor of CR occurrence wich might be overcome in some cases by antirejection treatment and the readjustment of immunosuppressive dosage.The typical pathologic manifestation of CR was smooth muscle proliferation of the graft vessels.