CAJ | 학술논문

移植肾活检1500例病理组织学分析
이식신활검1500례병리조직학분석
Histopathologic analysis of 1500 renal allograft biopsies

万方数据

中华医学杂志中華醫學雜誌 중화의학잡지
National Medical Journal of China
2011年 8期 520-523 ,共4页

郭晖%林正斌%张伟杰%明长生%陈知水%曾凡军%刘斌%蒋继贫%宫念樵%魏来%施辉波%杜敦峰%陈忠华%陈孝平

곽휘%림정빈%장위걸%명장생%진지수%증범군%류빈%장계빈%궁념초%위래%시휘파%두돈봉%진충화%진효평

肾移植%活组织检查,针吸%病理学腎移植%活組織檢查,針吸%病理學
신이식%활조직검사,침흡%병이학
Kidney transplantation%Biopsy,needle%Pathology

目的观察肾移植术后移植肾多种并发症的发生情况、病理组织学特点和活检诊断意义.方法在超声引导下对1997年1月至2010年5月华中科技大学同济医学院附属同济医院器官移植研究所的1500例肾移植受者移植肾施行了1712次经皮肾穿刺活检并对活检组织标本予以相应染色和病理组织学观察.结果肾移植术后可发生多种并发症,1500例中急性T细胞介导性排斥反应的发生率为14.2%(213例)、急性抗体介导性排斥反应发生率为2.4%(36例)、慢性T细胞介导性排斥反应发生率为16.7%(251例)、慢性抗体介导性排斥反应的发生率为3.0%(45例)、急性钙调磷酸酶抑制剂(CNI)类药物肾毒性损伤发生率为7.1%(106例)、慢性CNI类药物肾毒性损伤的发生率为16.7%(251例);复发/新发性肾病的发生率为0.4%(6例).排斥反应发生并不具有确定的时间界限.移植肾CNI类免疫抑制剂慢性毒性损伤是导致移植肾失功能的重要致病因素.结论移植肾活检病理学观察可以及时、准确地诊断肾移植术后的多种并发症,肾移植临床中应常规规范开展移植肾活检病理学诊断.
목적 관찰신이식술후이식신다충병발증적발생정황、병리조직학특점화활검진단의의.방법 재초성인도하대1997년1월지2010년5월화중과기대학동제의학원부속동제의원기관이식연구소적1500례신이식수자이식신시행료1712차경피신천자활검병대활검조직표본여이상응염색화병리조직학관찰.결과 신이식술후가발생다충병발증,1500례중급성T세포개도성배척반응적발생솔위14.2%(213례)、급성항체개도성배척반응발생솔위2.4%(36례)、만성T세포개도성배척반응발생솔위16.7%(251례)、만성항체개도성배척반응적발생솔위3.0%(45례)、급성개조린산매억제제(CNI)류약물신독성손상발생솔위7.1%(106례)、만성CNI류약물신독성손상적발생솔위16.7%(251례);복발/신발성신병적발생솔위0.4%(6례).배척반응발생병불구유학정적시간계한.이식신CNI류면역억제제만성독성손상시도치이식신실공능적중요치병인소.결론 이식신활검병이학관찰가이급시、준학지진단신이식술후적다충병발증,신이식림상중응상규규범개전이식신활검병이학진단.
Objective To summarize the histopathological features of posttransplant complications for renal allografts and evaluate the biopsy values. Methods Between January 1997 and May 2010, a total of 1712 percutaneous renal allograft biopsies were performed in 1500 kidney transplants and diagnostic procedures for staining, classification and staging had been performed according to the Banff 1997 and 2005 Schema. Results There were 213 ( 14.2% ) cases of acute T cell-mediated rejection post transplantation in 1500 kidney transplants. Meanwhile there were 36 ( 2.4%) cases of acute antibody-mediated rejection.Chronic T cell-mediated rejection and chronic antibody-mediated rejection were 251 ( 16.7% ) cases and 45 (3.0% )cases, respectively. Acute CNI-nephrotoxicity and chronic CNI-nephrotoxicity were 106 (7.1%)cases and 251 ( 16.7% ) cases, respectively. Relapsed or new nephropathy were 6 ( 0.4% ) cases. Chronic CNI-nephrotoxicity is the most common cause of allograft dysfunction in the long survival recipients.Conclusion Percutaneous renal allograft biopsy is valuable for the diagnosis of various posttransplantation complications.