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摘要: 抗体介导的排斥反应(AMR)已经成为导致移植物丢失的主要原因。C4d检测推动了AMR相关研究快速进展, 缺点是灵敏度不足。霉酚酸类药物联合他克莫司可作为AMR的维持性免疫抑制方案。目前AMR治疗方案很多, 但诸多因素影响AMR治疗的转归, 对晚期AMR尚无有效处理方法。本文从AMR的定义及诊断、C4d在AMR诊断中的作用及其局限性、AMR患者免疫抑制剂的选择、AMR的治疗措施、影响AMR治疗转归的因素、AMR面临的问题及展望等方面进行述评。关注体液性排斥, 改善移植肾预后, 任重而道远。
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表 1 抗体介导的排斥反应的治疗方法
Table 1. The treatment of antibody-mediated rejection
治疗方法 机制 血浆置换和免疫吸附 除去DSA IVIG 多重机制，主要是多向性的免
疫调节利妥昔单抗 抗CD20单克隆抗体，清除B细
胞硼替佐米 蛋白酶体抑制剂，可能引起正
常浆细胞凋亡，从而减少同种
抗体产生依库珠单抗 抗C5的人源化单克隆抗体 MMF和FK506 抑制DSA的产生 脾切除术 快速减少B细胞和浆细胞池 
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