Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ.
Am J Transplant. 2010 Mar;10(3):563-70. doi: 10.1111/j.1600-6143.2009.02966.x. Epub 2010 Feb 1.
Our aim was to study the impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy (IF/TA) on a 1-year protocol biopsy in patients on rapid steroid withdrawal (RSW). A total of 256 patients were classified based on protocol biopsy findings at months 1 or 4. Group 1 is 172 patients with no inflammation, group 2 is 50 patients with subclinical inflammation (SCI), group 3 is 19 patients with subclinical acute rejection (SAR) and group 4 is 15 patients with clinical acute rejection (CAR). On the 1-year biopsy, more patients in group 2 (SCI) (34%, p = 0.004) and group 3 (SAR) (53%, p = 0.0002), had an IF/TA score > 2 compared to group 1 (control) (15%). IF/TA was not increased in group 4 (CAR) (20%). The percent with IF/TA score > 2 and interstitial inflammation (Banff i score > 0) was higher in group 2 (16%, p = 0.004) and group 3 (37%, p < 0.0001) compared to group 1 (3%). In a multivariate analysis, patients in groups 2 or 3 had a higher risk of IF/TA score > 2 on the 1-year biopsy (OR 6.62, 95% CI 2.68-16.3). We conclude that SCI and SAR increase the risk of developing IF/TA in patient on RSW.
我们的目的是研究亚临床炎症对快速类固醇撤退（RSW）患者 1 年方案活检中间质纤维化和肾小管萎缩（IF/TA）发展的影响。根据第 1 个月或第 4 个月的方案活检结果，共对 256 名患者进行分类。第 1 组为 172 名无炎症患者，第 2 组为 50 名亚临床炎症（SCI）患者，第 3 组为 19 名亚临床急性排斥（SAR）患者，第 4 组为 15 名临床急性排斥（CAR）患者。在 1 年的活检中，与第 1 组（对照组）（15%）相比，更多的第 2 组（SCI）（34%，p=0.004）和第 3 组（SAR）（53%，p=0.0002）患者的 IF/TA 评分>2。在第 4 组（CAR）中，IF/TA 评分增加（20%）。第 2 组（SCI）（16%，p=0.004）和第 3 组（SAR）（37%，p<0.0001）的患者中，IF/TA 评分>2 且间质炎症（Banff i 评分>0）的比例高于第 1 组（3%）。在多变量分析中，第 2 组或第 3 组的患者在 1 年的活检中 IF/TA 评分>2 的风险更高（OR 6.62，95%CI 2.68-16.3）。我们得出结论，SCI 和 SAR 增加了 RSW 患者发生 IF/TA 的风险。
