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目的肾移植术后股骨头缺血性坏死撤除糖皮质激素的临床可行性研究。方法回顾分析了17例肾移植术后并发股骨头缺血性坏死患者的临床资料,其中,男性9例,女性8例,年龄最大62岁,最小31岁;12例为单侧股骨头缺血性坏死,5例为双侧股骨头缺血性坏死;发生时间为术后8～18个月,平均为13个月;17例患者肾移植术后均接受含激素的三联免疫抑制治疗方案,在确诊为股骨头缺血性坏死后均迅速减少激素用量,并于1周内撤除;撤除糖皮质激素后,对缺血坏死的股骨头进行综合性治疗,同时,密切观察患者的移植肾功能、尿蛋白、排斥反应等。结果在558例肾移植患者中,并发不同程度的股骨头缺血性坏死17例,发病率为3%(17/558);17例经撤除糖皮质激素、中药及理疗,16例症状消失,逐渐康复;1例无效,行左侧髋关节置换术;所有患者在撤除糖皮质激素后多次复查肾功能均正常,未出现急性排斥反应,其中,2例在撤除糖皮质激素2周后,出现蛋白尿++～+++,检测CsA浓度低于100μg/ml,遂改用FK506同时加用雷公藤治疗,2个月后蛋白尿转阴。结论肾移植患者长期使用糖皮质激素容易导致股骨头缺血性坏死;及时撤除激素,同时给予综合治疗,对缺血坏死的股骨头仍能取得很好的效果;撤除激素对移植肾有一定影响,不可作为预防肾移植术后股骨头缺血坏死的常规方法;撤停激素的时间应在肾脏移植手术8个月以后。
Objective To investigate the clinical feasibility of removing glucocorticoid after avascular necrosis of the femoral head after renal transplantation. Methods The clinical data of 17 patients with avascular necrosis of the femoral head after renal transplantation were retrospectively analyzed. Among them, 9 were males and 8 were females, the oldest was 62 years old and the youngest was 31 years old. Twelve cases were unilateral femoral head ischemia 5 cases were bilateral avascular necrosis of femoral head. The time was 8 to 18 months after operation, with an average of 13 months. Seventeen patients received hormone-containing triple immunosuppressive regimen after renal transplantation, After the diagnosis of avascular necrosis of femoral head were rapidly reduced the amount of hormones, and removed within 1 week; removal of glucocorticoid, the ischemic necrosis of the femoral head for comprehensive treatment, while close observation of the patient’s renal graft function Urinary protein, rejection and so on. Results In 558 renal transplant recipients, 17 cases of ischemic necrosis of the femoral head were complicated with varying degrees of incidence of 3% (17/558). In 17 cases, the symptoms of 16 cases disappeared after removing glucocorticoid, traditional Chinese medicine and physical therapy, Gradually recovered; 1 case was invalid, left hip replacement; all patients after repeated removal of glucocorticoid renal function were normal, no acute rejection, of which 2 cases after 2 weeks of removing glucocorticoid, Proteinuria ++ ~ +++, CsA concentration less than 100μg / ml, then use FK506 plus Tripterygium treatment, 2 months after the proteinuria negative. Conclusion Long-term use of glucocorticoid in renal transplant patients can lead to avascular necrosis of the femoral head. Timely withdrawal of hormones, combined with comprehensive treatment, can still achieve good results in the treatment of necrosis of the femoral head. , Can not be used as a prevention of avascular necrosis of the femoral head after conventional renal transplantation; withdrawal of hormone time should be kidney transplant surgery after 8 months.