ABO血型不合肝移植的研究进展.doc

1、guarantee for the great struggle. This aspects XI General Secretary of speech main including exercise thrift, against extravagance mass line is party of lifeline and fundamental work route accurate grasp party of mass line education practice activities of guideline and target requirements set and de

2、velop “three strict three real“ of style put power shut into system of cage in using history wisdom advance anti-corruption construction in-depth advance style clean government and anti-corruption struggle develop nail nail of spirit, a Zhang good of blueprint worked to. 9. other aspects. 18 big yil

3、ai, XI General Secretary also respectively on diplomatic, and military, and ecological construction, aspects published has important speech, covers has construction ecological civilization, and advance defense and army modern, and rich “one country, two systems“ practice and advance country unified,

4、 and go peace development road, and promoted building new powers relationship, and go good around diplomatic work, and strengthening and developing countries solidarity cooperation, and active participation multilateral affairs, and science of thinking and work method, many aspects. XI Jinping, Secr

5、etary of a series of important speeches, and further enrich and develop the partys theory, line, principles and policies, the party puts forward new requirements for more contemporary features, the latest achievement of Marxism in China, is a guide to persisting and developing socialism with Chinese

6、 characteristics. Four methods. To address the relationship between comprehensive and focused on science. In the process of learning, we should follow as a good study and carry out the “wise men“ to conduct a comprehensive collaborative learning; and with their own jobs, focus research and understan

7、ding spirit, grasp the potential requirements. For example, every party member should be according to the various branches of learning program, an article does not go into a link, no leakage of conducting a comprehensive study, and combined with their own duties and responsibilities, be focused and

8、targeted Geoscience. Like, leaders to highlight learning XI on ruling acting political know of deep love of cut dry in practice go in forefront of river new language out poverty XI on coordination advance “four a full“ strategy layout discusses excerpts XI on full deepening reform discusses excerpts

9、 XI on full law ruling discusses excerpts 18 big yilai XI on major economic problem discusses excerpts, discipline to highlight learning XI on strict party of discipline and rules discusses excerpts XI Jinping, on the construction of clean and honest Government and fight against corruption discussed

10、 excerpts, technology to highlight the learning of the XI Jinping on technological innovation and discusses excerpts, XI Jinping, education should highlight the important excerpts of work on education and so on. To address the relation between stage and often science. Phase has the advantage of time

11、 to focus on fast, to highlight the theme, focused, result; often learn the advantages of flexible fit, form, subtle, continues todeepen. In General, periodic high priority on learning, easy to grasp and practice: recurrent learning factors, long time, prone to “sluggish“. Learning programmes are ex

12、plicitly required to learn education is not an event, but to highlight the normal education, differentiated levels, heart, catch a fine practice, the real partys ideological and political construction in the everyday, often. This requires that we do a good job phase focused learning based on knowled

13、ge contests, comments on rewards in the form, pay special attention to recurring studies. To handle the relationship between solid strong to learn and a lot to learn. For any unit or individual, objectively speaking, in the process of carrying out the party Constitution Party rules and spirit, there

14、 is a problem with strong and weak, which we need to pay attention to the actual learning content, and handle the relationship between solid strong to learn and a lot to learn. On one hand, we must always keep a humble attitude, good deal, Continue the hardening. The other hand, always keep the spir

15、it of energetic, pegged to the weak link to find gaps, fill the short Board. Short Board issues should not be underestimated, the saying goes, have short Board, add a short. This tells us, there are weaknesses shortcomings and do not be afraid, fear is a blind eye and not to repair, the result is po

16、or is worse and the weak weaker. United States politics home zhamusi, and Wilson and prevention crime learn experts qiaozhikailin proposed has a famous of broken window theory, that, if a building House has a fan window of glass broken has, and this fan Windows no get timely repair, others on May to

17、 broke more of window glass, time a long, these damaged of window on to people caused a disorder, and matter of feel, results in this mass errors think no attention, and no management of atmosphere Xia, some bad culture, and violations behavior on will breeding and spread. Reality life in the is suc

18、h, clean of wall Shang, suddenly was posted has a Zhang ad, if didnt people management, not out days this wall Shang on will appeared greatly small many of advertising; private take mess built phenomenon is so, began circle a small block to built a small shed put things, if didnt people timely stop,

19、 he on dare built a hut live people, time long has didnt people tube, wants to tube Shi on difficult has. Therefore, the solid strong is important, a lot to learn is also important. Third, key, grasp the learning objective of education is to train a qualified party member “two“ study and education t

20、o its core essence is learning and doing. Learning and doing are mutually reinforcing, if optical cant do, study leave, real learning deficiency, while sweating, wind and water, “one fishing white“ became “fake words and not the mules“. Learning party rules did not comply with the party Constitution

21、, address the learning series is not used, instead, learn and do, imagine this “learning“, how do you meet the eligibility requirements of party members. Therefore, the “two“ basic learning, the key is in use, do, line. In particular, is a qualified party members to grasp the following three points.

22、 To strengthen “fourABO 血型不合肝移植的研究进展正常情况下，肝移植受者与供者的血型要相一致或相容时才能实施，但在临床上常会遇到捐赠者与受者 ABO 血型不一致的现象。为了增加供肝数量，人们开始考虑并开展 ABO 血型不合肝移植。目前，在紧急或供者紧缺的情况下行 ABO 血型不合肝移植已逐渐被接受，甚至有关于原发性肝癌 ABO 血型不合肝移植的报道。一、ABO 血型不合肝移植的理论基础与现状肝脏作为免疫特惠器官，有较好的免疫耐受能力。肝脏具有产生 ABO 抗原的能力，可以诱发产生阻断性抗体，同时，肝细胞是体内少数无 ABO 抗原存在的细胞。此外，在某些特殊人群中，如供者移

23、植物血型抗原表达低下及受者免疫系统不成熟时，也为血型不合肝移植提供了可行性。肝脏免疫与结构的特殊性及人群个体免疫差异为 ABO 血型不合的肝移植提供了理论基础。ABO 抗原在血管内皮细胞内是一种重要的移植抗原，移植时必须合理组合。由于人类 ABO 抗原不仅存在于红细胞表面，也存在于移植肝脏的血管内皮、胆管上皮和肝窦内皮细胞表面，当血型不合的供者器官植入受者体内后，会引发一系列超急性、急性及慢性排斥反应，攻击上述靶细胞，使得血型不合肝移植受者在急性排斥反应及胆道、血管并发症方面会有更高的发生率，且移植物的存活率较低。早期 ABO 血型不合肝移植的并发症较多，移植物存活率较低。因此，早期移植中心对

24、供受者血型不合肝移植多持反对态度。近 10 年来，由于治疗上的改进， ABO 血型不合肝移植受者的预后有了明显改善。在紧急或供肝紧缺的情况下行供、受者 ABO 血型不合肝移植已逐渐被接受，甚至在肝癌患者肝移植中也有应用报道。二、ABO 血型不合肝移植跨越血型屏障的干预方法目前针对血型不合肝移植如何跨越血型屏障，临床处理主要有以下几种方法。1血浆去除术：血浆去除术的目的在于清除受者血中的抗 A 抗 B 凝集素水平，改善血型不合肝移植预后。有研究表明，移植术前减少凝集素水平和维持术后最初几周低凝集素水平是预防因血型不合移植而发生排斥反应的一个非常重要的经验。Haga 等报道在 41 例 ABO 血

25、型不合的肝移植中，凝集素 IgM 高滴度组和低滴度组的移植物 1 年存活率分别为 38% 和 70%。Mor 等认为血细胞凝集素水平在 1:16 以下，能减少移植物失活的风险，但即使同种血细胞凝集素滴度低于 1:8，也不能完全避免排斥反应发生。Testa 等在血型不合活体肝移植中应用血浆去除法，将直至术后 3 个月的抗凝集素水平保持在 1：16 以下。guarantee for the great struggle. This aspects XI General Secretary of speech main including exercise thrift, against extra

26、vagance mass line is party of lifeline and fundamental work route accurate grasp party of mass line education practice activities of guideline and target requirements set and develop “three strict three real“ of style put power shut into system of cage in using history wisdom advance anti-corruption

27、 construction in-depth advance style clean government and anti-corruption struggle develop nail nail of spirit, a Zhang good of blueprint worked to. 9. other aspects. 18 big yilai, XI General Secretary also respectively on diplomatic, and military, and ecological construction, aspects published has

28、important speech, covers has construction ecological civilization, and advance defense and army modern, and rich “one country, two systems“ practice and advance country unified, and go peace development road, and promoted building new powers relationship, and go good around diplomatic work, and stre

29、ngthening and developing countries solidarity cooperation, and active participation multilateral affairs, and science of thinking and work method, many aspects. XI Jinping, Secretary of a series of important speeches, and further enrich and develop the partys theory, line, principles and policies, t

30、he party puts forward new requirements for more contemporary features, the latest achievement of Marxism in China, is a guide to persisting and developing socialism with Chinese characteristics. Four methods. To address the relationship between comprehensive and focused on science. In the process of

31、 learning, we should follow as a good study and carry out the “wise men“ to conduct a comprehensive collaborative learning; and with their own jobs, focus research and understanding spirit, grasp the potential requirements. For example, every party member should be according to the various branches

32、of learning program, an article does not go into a link, no leakage of conducting a comprehensive study, and combined with their own duties and responsibilities, be focused and targeted Geoscience. Like, leaders to highlight learning XI on ruling acting political know of deep love of cut dry in prac

33、tice go in forefront of river new language out poverty XI on coordination advance “four a full“ strategy layout discusses excerpts XI on full deepening reform discusses excerpts XI on full law ruling discusses excerpts 18 big yilai XI on major economic problem discusses excerpts, discipline to highl

34、ight learning XI on strict party of discipline and rules discusses excerpts XI Jinping, on the construction of clean and honest Government and fight against corruption discussed excerpts, technology to highlight the learning of the XI Jinping on technological innovation and discusses excerpts, XI Ji

35、nping, education should highlight the important excerpts of work on education and so on. To address the relation between stage and often science. Phase has the advantage of time to focus on fast, to highlight the theme, focused, result; often learn the advantages of flexible fit, form, subtle, conti

36、nues todeepen. In General, periodic high priority on learning, easy to grasp and practice: recurrent learning factors, long time, prone to “sluggish“. Learning programmes are explicitly required to learn education is not an event, but to highlight the normal education, differentiated levels, heart,

37、catch a fine practice, the real partys ideological and political construction in the everyday, often. This requires that we do a good job phase focused learning based on knowledge contests, comments on rewards in the form, pay special attention to recurring studies. To handle the relationship betwee

38、n solid strong to learn and a lot to learn. For any unit or individual, objectively speaking, in the process of carrying out the party Constitution Party rules and spirit, there is a problem with strong and weak, which we need to pay attention to the actual learning content, and handle the relations

39、hip between solid strong to learn and a lot to learn. On one hand, we must always keep a humble attitude, good deal, Continue the hardening. The other hand, always keep the spirit of energetic, pegged to the weak link to find gaps, fill the short Board. Short Board issues should not be underestimate

40、d, the saying goes, have short Board, add a short. This tells us, there are weaknesses shortcomings and do not be afraid, fear is a blind eye and not to repair, the result is poor is worse and the weak weaker. United States politics home zhamusi, and Wilson and prevention crime learn experts qiaozhi

41、kailin proposed has a famous of broken window theory, that, if a building House has a fan window of glass broken has, and this fan Windows no get timely repair, others on May to broke more of window glass, time a long, these damaged of window on to people caused a disorder, and matter of feel, resul

42、ts in this mass errors think no attention, and no management of atmosphere Xia, some bad culture, and violations behavior on will breeding and spread. Reality life in the is such, clean of wall Shang, suddenly was posted has a Zhang ad, if didnt people management, not out days this wall Shang on wil

43、l appeared greatly small many of advertising; private take mess built phenomenon is so, began circle a small block to built a small shed put things, if didnt people timely stop, he on dare built a hut live people, time long has didnt people tube, wants to tube Shi on difficult has. Therefore, the so

44、lid strong is important, a lot to learn is also important. Third, key, grasp the learning objective of education is to train a qualified party member “two“ study and education to its core essence is learning and doing. Learning and doing are mutually reinforcing, if optical cant do, study leave, rea

45、l learning deficiency, while sweating, wind and water, “one fishing white“ became “fake words and not the mules“. Learning party rules did not comply with the party Constitution, address the learning series is not used, instead, learn and do, imagine this “learning“, how do you meet the eligibility

46、requirements of party members. Therefore, the “two“ basic learning, the key is in use, do, line. In particular, is a qualified party members to grasp the following three points. To strengthen “fourKim 等报道了 22 例血型不合活体肝移植，血浆置换的抗凝集素水平术前控制在 1：8 以下，而术后控制目标为保持直至术后 2 周低于 1:32，受者恢复良好。一般认为，对于术前血液凝集素效价 1：16 者

47、，术前应进行血浆置换。移植术后不常规行抗体去除治疗，但需随时监测凝集素滴度变化，当术后 1 周抗体水平明显升高，超过 64:1 时或病理证实有抗体介导的排斥反应发生则继续用此法治疗。有研究表明，ABO 血型不合活体肝移植治疗性血浆置换的方案，在时机和频率上，与肝移植是有区别的。国内肝移植多为急诊进行，短时间内往往不能找到足够的血浆进行置换，同时术前血浆置换会延长供肝的冷缺血时间，因此术前血浆置换并不能常规进行。对那些接受急诊 ABO 血型不合肝移植且有高效价 ABO 抗体滴度的患者，较佳的血浆置换联合免疫抑制治疗的方案尚未统一标准。免疫吸附法可达到和血浆置换相同的效果，有特异性结合抗体、选择性

48、高、不需血浆及不良反应较小等优点。Troisi 等报道 5 例血型不符的肝移植者术前给予抗原特异性免疫吸附，IgM 和 IgG 均降低，术后采用他克莫司、吗替麦考酚酯、达利珠单抗预防排斥反应，不伴脾切除，受者均存活，中位随访时间 18 个月。Boberg 等报道 1 例 ABO 血型不合肝移植者术前、术后使用血浆置换抗体滴度仍然升高情况下，使用免疫吸附仍获得良好疗效。近年来，吸附材料的改进使得免疫吸附法有了更高的抗体清除效果。2利妥昔单抗：利妥昔单抗可通过补体依赖性细胞毒性、药物诱导的凋亡及抗体依赖性细胞毒性的作用，选择性清除 B 淋巴细胞，抑制体液免疫反应。Usuda 等报道血型不合肝移植受

49、者术后使用利妥昔单抗可安全有效的对抗体液排斥反应。Egawa 等认为，早期使用利妥昔单抗可以显著清除脾脏中 B 细胞及记忆 B 细胞的数量，但对淋巴结中的 B 细胞无影响，这也表示早期应用利妥昔单抗来清除 B 细胞与体液排斥反应发生率趋势降低相关。Shimoda 等发现，ABO 血型不合肝移植受者中，术前单独使用利妥昔单抗，预防体液排斥反应的效果相对不足，他们推荐脾切除联合利妥昔单抗的使用。Matsuno 等报道 8 例 ABO 血型不合原发性肝癌肝移植受者，其中 5 例使用了单倍剂量的利妥昔单抗，4 例存活。Usui 等认为在血型不合肝移植受者中，使用利妥昔单抗不仅安全且主要不良反应较少，但感染并发症则不容忽视。而近年来不少研究显示，利妥昔单抗的成功使用已经在很大程度上取代了脾脏切除和肝脏灌注这些有创及存在较大风险的操作，甚至有研究者称血型不合肝移植已进入了利妥昔单抗时代。guarantee for the great struggle. This aspects XI General Secretary of speech main including exercise thrift, against extravagance mass line is party of lifeline and fundamental