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目的：探讨急性血管性排斥反应的临床、病理和免疫病理特点，指导临床诊断治疗，判断预后。方法：根据移植肾病理将３２例早期急性排斥患者分为急性血管性排斥（ＡＶＲ）组和急性细胞性排斥（ＡＣＲ）组，通过临床、移植肾病理和免疫病理变化的对照研究，观察分析ＡＶＲ患者血清肌酐、肾组织病理和免疫病理的变化特征及其治疗反应。结果：①ＡＶＲ常发生于术后第７天内（９０．５％）。ＡＶＲ组Ｌｓｃｒ、Ｂｓｃｒ、Ｈｓｃｒ和Ｖｓｃｒ明显高于ＡＣＲ组，ＡＶＲ组Ｖｓｃｒ的升高是ＡＣＲ组的２倍。肾移植后随访６个月，ＡＶＲ组移植肾的丧失率高于ＡＣＲ组，分别为２３．８％和１８．２％；②ＡＶＲ肾组织主要病理改变：动脉内膜炎（６６．７％），血管内血栓形成（４．８％），肾小球炎（７６．２％），肾小球袢内血栓（９．５％）和袢坏死（１９．１％），肾间质大量出血（３３．３％），无小管炎，肾间质仅有散在细胞浸润。ＡＶＲ肾组织动脉内膜炎、肾小球袢内血栓、袢坏死和肾间质大量出血等病理改变，对常规甲基强的松龙（ＭＰ）冲击治疗无显效，预后也很差；③ＡＶＲ组和ＡＣＲ组肾间质ＣＤ４＋、ＣＤ８＋、ＣＤ６８＋、Ｂ细胞、ＰＣＮＡ、ＩＬ－２Ｒ和ＨＬＡ－ＤＲ阳性小管细胞均明显升高。ＡＶ?
Objective: To investigate the clinical, pathological and immunopathological features of acute vascular rejection, to guide the clinical diagnosis and treatment and to judge the prognosis. Methods: Thirty-two cases of early acute rejection were divided into acute vascular rejection (ACR) group and acute cellular rejection (ACR) group according to the pathological grafts of renal allografts. The clinical and pathological changes of renal allografts and the control study of immunopathological changes were observed and analyzed. Changes of serum creatinine, renal histopathology and immunopathology and its response to treatment. Results: ① AVR often occurred within 7 days after operation (90.5%). AVR group Lscr, Bscr, Hscr and Vscr was significantly higher than the ACR group, AVR group Vscr increased ACR group 2 times. After 6 months of renal transplantation, the loss of graft in the AVR group was significantly higher than that in the ACR group (23.8% and 18.2%, respectively). ② The main pathological changes in AVR renal tissues were endarteritis (66.7%), Intravascular thrombosis (4.8%), glomerulonephritis (76.2%), glomerular thrombosis (9.5%) and gallbladder necrosis (19.1%), extensive renal interstitium ( 33.3%), no tubal inflammation, renal interstitial scattered scattered only in cells. AVR renal artery endocarditis, thrombosis of glomeruli, gallbladder necrosis and a large number of bleeding and other renal interstitial pathological changes, conventional methylprednisolone (MP) impact treatment was ineffective, the prognosis is poor; ③ AVR group The number of CD4 +, CD8 +, CD68 +, B cells, PCNA, IL-2R and HLA-DR positive tubular cells in renal interstitium and ACR group were significantly increased. AV?