抗体介导排斥反应的精准诊疗

Precision diagnosis and treatment of antibody-mediated rejection

通过分析抗体介导的排斥反应(antibody-mediated rejection,AMR)的发生机制和急慢性组织损伤的病理学特征,提出4个AMR的对因和对症防治措施:①针对AMR的病因,清除抗体和抗体产生细胞;②针对抗体引起的原发性内皮损伤机制,阻断补体依赖的损伤机制和阻断抗体依赖细胞介导的损伤;③针对内皮损伤后继发性的微血管管腔内血栓形成,进行抗凝溶栓治疗;④针对内皮损伤后继发性的急慢性血管性炎症反应进行抗炎治疗。本文强调,"对因措施"在AMR的防治中是最为重要的,但抗凝、溶栓和抗炎等对症措施也不可被忽视。最后,本文根据这些防治措施各自不同的特点和适应证,针对非致敏和致敏患者AMR的预防、活动性AMR受者的治疗、慢性活动性AMR受者的治疗,分别提出相应的综合防治建议方案。

Based upon the underlying mechanism and pathological evidence of tissue injury of antibody-mediated rejection(AMR),four etiological and symptomatic therapies were proposed for managing AMR,including etiological treatment of AMR including antibody-targeting,B cell or plasma cell-targeting therapies;strategies for preventing antibody-mediated endothelial damage:an inhibition of complement/antibody dependent cell-mediated pathways;anticoagulant&thrombolytic therapies for thrombotic microangiopathy secondary to endothelial damage;anti-inflammatory therapies for acute/chronic vascular inflammation secondary to endothelial damage.Etiological treatment is essential for preventing and treating AMR while symptomatic measures,such as anticoagulant,thrombolytic and antiinflammatory therapies,are stressed.Finally the authors devised therapeutic strategies for AMR in 4 different patient groups of non-sensitized allograft recipients,sensitized allograft recipients,individuals with active AMR and those with chronic active AMR.