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GRHPR基因突变的Ⅱ型原发性高草酸尿症致早期移植肾功能丧失一例

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中华器官移植杂志 2018年第3期39卷 174-176页

作者：高宝山王钢周洪澜傅耀文吉林大学第一医院泌尿外二科长春130021

原发性高草酸尿症是一种罕见的遗传性疾病，该疾病可导致慢性肾功能衰竭，且单纯行肾脏移植手术预后不良。我院1例GRHPR基因突变的II型原发性高草酸尿症患者行肾移植手术后早期出现移植肾功能丧失，报告如下。

关键词：原发性高草酸尿症肾功能丧失早期移植基因突变肾脏移植手术慢性肾功能衰竭遗传性疾病 Ⅱ型

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维普期刊数据库

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内皮损伤和获得性阿司匹林抵抗是冠状动脉搭桥术后局灶性血栓形成和早期静脉移植失败的启动因素

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世界核心医学期刊文摘（心脏病学分册） 2006年第5期2卷 59-60页

作者： Poston R.S Brown J.M. 刘少伟 Department of Surgery Division of Cardiac Surgery N4W94 22 S Greene St Baltimore MD 21201 United StatesDr.

Objective: The predominant mechanism of early graft failure after coronary artery bypass grafting remains in doubt. Aspirin administered in the initial hours after coronary artery bypass grafting improves graft patency, implicating prostanoid synthesis in the pathogenesis. We hypothesized that synergy between endothelial disruption in the venous conduit and aspirin resistance would cause vein graft failure. Methods: Aspirin resistance, defined by diagnostic findings on at least two of three separate assays, was serially assessed in 225 patients undergoing off-pump coronary artery bypass grafting. Endothelial cell integrity was determined in surplus segments obtained from 408 vein grafts. The deposition of intraluminal thrombin within the vein was determined by comparing serum F1.2 levels between the coronary sinus and the aorta after grafting. Intraoperative blood flow in the grafts was measured with transit-time technology, and patency was assessed with electrocardiographically gated multichannel computed tomographic coronary angiography on day 5. Aspirin was the sole antithrombotic agent used during the study. Results: Thrombosed grafts(16/408) showed more endothelial cell loss at the time of grafting than did those grafts that remained patent(10.8% ± 21.5% vs 51.4% ± 39.1% integrity, P< .01). Aspirin resistance occurred in 67 patients(30% ). Graft thrombosis was associated with aspirin resistance(P< .04) and reduced endothelial integrity(P< .01). These factors coexisted in 14 of 16 grafts that failed and were associated with elevated coronary sinus F1.2 levels. Conclusion: Aspirin resistance and relatively compromised venous endothelial cell integrity together marked patients whose vein grafts failed within days after off-pump coronary artery bypass grafting. These observations form a basis for identifying patients at risk and developing approaches to prevent vein injury or to selectively intervene in high-risk circumstances.

关键词：非体外循环下冠状动脉搭桥术阿司匹林抵抗静脉移植内皮损伤早期移植血栓形成术后局灶性获得性冠状动脉血管造影

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CYP3A基因多态性与肾移植后早期钙调磷酸酶抑制剂的应用

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中华器官移植杂志 2012年第9期33卷 519-522页

作者：张小东首都医科大学附属北京朝阳医院泌尿外科 100020

免疫抑制不足或过度是早期移植肾功能丧失的主要原因之一，移植后1年内若能避免发生急性排斥反应，将会有助于提高移植物的长期存活率。钙调磷酸酶抑制剂（CNI）为目前大多数实体器官移植术后免疫抑制剂方案的基础，但因其治疗窗狭窄，... 详细信息

免疫抑制不足或过度是早期移植肾功能丧失的主要原因之一，移植后1年内若能避免发生急性排斥反应，将会有助于提高移植物的长期存活率。钙调磷酸酶抑制剂（CNI）为目前大多数实体器官移植术后免疫抑制剂方案的基础，但因其治疗窗狭窄，个体间药代动力学差异显著以及药效动力学与药物浓度的相关性差等特点，其临床应用受到限制。因此，如何根据个体需要而个体化使用CNI，以优化免疫抑制剂的效果，减少毒性等不良反应，依然是实体器官移植面临的一个难题。

关键词：钙调磷酸酶抑制剂肾功能丧失早期移植临床应用移植后基因多态性 CYP3A 实体器官移植

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