CAJ | 학술논문

目的探讨移植肾失功的原因和移植肾血管病(ARA)的发生机理.方法对74例切除的无功能移植肾进行了临床病理分析,并应用免疫组织化学、免疫金电镜分别观察了24例和5例发生ARA的移植肾的形态.结果 74例无功能肾中急性排斥反应(AR)占89.2%(66/74),慢性排斥反应(CR)占36.5%(27/74).ARA的特征性形态为移植肾内动脉内膜呈向心性纤维性增厚,其中可见以T淋巴细胞为主的炎性细胞浸润;内皮细胞增生、肥大,并异常表达Ⅱ类主要组织相容性抗原(HLA-D).结论 AR是造成移植肾无功能的最常见原因;ARA是CR的特征性病变,ARA可能是血管内皮损伤后T淋巴细胞介导的一种动脉内膜炎症.
목적 탐토이식신실공적원인화이식신혈관병(ARA)적발생궤리.방법 대74례절제적무공능이식신진행료림상병리분석,병응용면역조직화학、면역금전경분별관찰료24례화5례발생ARA적이식신적형태.결과 74례무공능신중급성배척반응(AR)점89.2%(66/74),만성배척반응(CR)점36.5%(27/74).ARA적특정성형태위이식신내동맥내막정향심성섬유성증후,기중가견이T림파세포위주적염성세포침윤;내피세포증생、비대,병이상표체Ⅱ류주요조직상용성항원(HLA-D).결론 AR시조성이식신무공능적최상견원인;ARA시CR적특정성병변,ARA가능시혈관내피손상후T림파세포개도적일충동맥내막염증.
Objective To investigate the causes leading the failure of kidney transplantation and the pathogenesis of arteriopathy of renal allograft (ARA).Methods Clinical pathological studies were retrospectively performed on 74 cases of failed renal allografts.Among the 74 cases,24 and 5 of ARA underwent the morphological observation on the renal allografts by immunohistochemistry and under a immunogold electron microscope,respectively.Results In 74 cases of failed renal allografts,acute rejection (AR) occurred in 66 cases (89.2%)and chronic rejection(CR) in 27 cases(36.5%).The morphological characteristics in ARA included intimal fibrous proliferation with predominamt T lymphocyte infiltration.The vascular endothelial cells were hypertrophy and had the abnormal expression of class Ⅱ HLA-D.Conclusion AR might be the most common causes resulting in the failed renal allografts.ARA was a characteristic lesion and might be an endothelialitis triggered by endothelial injury and mediated by T lymphocytes.