【摘要】 目的:探讨环孢素A(CsA)移植肾毒性损害的病理特点及其临床应用效果。方法:选取2017年3月-2018年3月本院收治的肾移植患者70例。根据肾损伤情况将其分为研究组(n=40,发生肾毒性损害)和对照组(n=30,未发生肾毒性损害)。两组患者在肾移植后均服用环孢素胶囊,分析研究组CsA移植肾毒性损害的病理特点,比较两组总胆汁酸(TBA)、血清总胆红素(STB)、丙氨酸氨基转移酶(ALT)异常情况,研究组不同CsA血药浓度与肝功能指标情况。结果:研究组中急性肾毒性损害38例(其中合并急性排斥6例,合并肾小管坏死11例),急性患者的病理表现主要为肾小管毒性损害,嗜银染色肾小管基底膜未发现明显增厚现象,一小部分上皮细胞内发生了钙化沉着与包涵体样物,肾近曲小管上皮细胞有大小不一的空泡样变;慢性肾毒性损伤2例,主要的病理表现为近肾小球细小动脉表现为黏液与玻璃样病变,肾间质表现为病灶状纤维化、嗜银染色、纤维化区域没有明显的细胞浸润、基底膜增厚、没有肾小管上皮发生萎缩。研究组TBA、STB、ALT异常率均高于对照组(P<0.05)。CsA血药浓度>600 ng/mL的TBA、STB、ALT水平及肝损伤发生率均高于其他血液浓度(P<0.05)。结论:患者进行肾移植后给予CsA的过程中,要对患者的血药浓度进行密切的监测,同时要根据患者的肝功能情况,对CsA的使用剂量进行调整,以预防或减轻患者肾毒性损害的发生。更多还原

【Abstract】 Objective:To investigate the pathological features and clinical application of cyclosporine A(CsA)in toxic damage of transplanted kidney.Method:A total of 70 patients with renal transplantation admitted to our hospital from March 2017 to March 2018 were selected.According to the condition of kidney injury,they were divided into study group(n=40,with nephrotoxic damage)and control group(n=30,without nephrotoxic damage).Cyclosporine Capsules were taken after kidney transplantation in both groups.The pathological characteristics of renal toxicity damage after CsA transplantation was analyzed in study group.the abnormalities of total bile acid(TBA),serum total bilirubin(STB)and alanine aminotransferase(ALT)between two groups were compared,the levels of liver function indices in different serum CsA concentrations in study group were compared.Result:There were 38 cases of acute nephrotoxic damage in study group(included6 cases of complicated with acute rejection and 11 cases of complicated with tubular necrosis),the pathological manifestation of acute patients was mainly renal tubule toxicity damage,no significant thickening was found in the basilar membrane of silver-stained renal tubule,calcification and inclusion bodies occurred in a small number of epithelial cells,and renal proximal tubule epithelial cells,there were different sizes of vacuoidal changes;chronic nephrotoxic injury occurred in 2 cases,the main pathological manifestations were mucinous and vitreous lesions in the small near glomerular arterioles,focal fibrosis in the renal interstitium,argyrophilic staining,no obvious cell infiltration in the fibrotic area,basement membrane thickening,and no atrophy of tubular epithelium.The abnormal rates of TBA,STB and ALT in study group were higher than those of control group(P<0.05).The levels of TBA,STB,ALT and the incidence of liver injury in patients with CsA blood concentration>600 ng/mL were higher than those of other blood concentrations(P<0.05).Conclusion:During the course of giving CsA after kidney transplantation,patients’ blood drug concentration should be closely monitored,at the same time,the dosage of CsA should be adjusted according to patients’ liver function to prevent or alleviate the occurrence of renal toxicity damage.更多还原