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目的 探讨肾移植术后早期巨细胞病毒 (CMV)感染与慢性移植物肾病 (CAN)的关系。 方法 1999年 8月至 2 0 0 0年 12月行肾移植并随访 3年的患者 77例 ,根据术后 6个月内外周血CMV pp6 5 ( + )白细胞计数的数量和持续时间 ,将其分为 :非活动性 (A组 ,n =15 )、低活动性 (B组 ,n=32 )、短期高活动性 (C组 ,n =18)和长期高活动性 (D组 ,n =12 )CMV感染 4组。 6个月后行移植肾穿剌活检 ,通过免疫荧光和逆转录聚合酶链反应 (RT PCR)比较 4组患者肾组织中转移生长因子β1(TGF β1)蛋白和mRNA的表达量 ;3年后比较 4组患者肾功能不全 (血肌酐持续 >114 μmol/L)的发生率和肌酐清除率 (Ccr)减损量 ;对肾功能不全的患者通过活检明确是否为CAN。 结果 肾移植 6个月后A、B、C组TGF β1蛋白表达量分别为 :( 5 .82± 1.32 )× 10 6、( 6 .34± 1.4 7)× 10 6和 ( 6 .5 8± 1.4 4 )× 10 6,TGF β1mRNA分别为 :0 .84± 0 .17、0 .78± 0 .15和 0 .82± 0 .16 ;D组TGF β1蛋白和mRNA表达量分别为 ( 10 .4 7± 2 .12 )× 10 6和 1.37± 0 .2 5 ,均明显高于前 3组 (P <0 .0 1)。前 3组 3年内Ccr减损量分别为 :( 5 .6± 5 .2 )、( 6 .2± 6 .4 )和 ( 5 .9± 4 .7)ml/min ;D组为 ( 15 .8± 9.6 )ml/min ,明显高于前 3组
Objective To investigate the relationship between early cytomegalovirus (CMV) infection and chronic allograft nephropathy (CAN) after renal transplantation. Methods From August 1999 to December 2000, 77 patients who underwent renal transplantation and were followed up for 3 years were divided into two groups according to the number and duration of CMV pp6 5 (+) leukocytes in peripheral blood within 6 months after operation (Group A, n = 15), low activity (group B, n = 32), short term high activity (group C, n = 18) and long term high activity 12) CMV infection in 4 groups. Six months later, the renal allograft biopsy was performed. The expression of TGF-β1 protein and mRNA in renal tissues was compared between the four groups by immunofluorescence and reverse transcription-polymerase chain reaction (RT PCR). Three years later The incidences of renal dysfunction (continuous serum creatinine> 114 μmol / L) and creatinine clearance (Ccr) were compared between the 4 groups. The renal insufficiency was confirmed by biopsy for CAN. Results The expression of TGF-β1 in group A, B and C at 6 months after renal transplantation were (5.82 ± 1.32) × 10 6, (6.34 ± 1.4 7) × 10 6 and (6.58 ± 1.4 4) × 10 6, TGF β 1 mRNA were 0.84 ± 0.17, 0.78 ± 0.15 and 0.82 ± 0.16, respectively. The expression of TGFβ1 protein and mRNA in group D were (10. 4 7 ± 2 .12) × 10 6 and 1.37 ± 0. 25, respectively, were significantly higher than those in the first three groups (P <0.01). The Ccr impairment in the first three groups were (5.6 ± 5.2) days, (6.2 ± 6.4) days and (5.9 ± 4.7) days / 8 ± 9.6) ml / min, significantly higher than the first three groups