肾移植术后环孢素肾中毒的临床与病理学研究

CLINICAL AND PATHOLOGIC MORPHOLOGY STUDY OF CsA NEPHROTOXICITY IN THE PATIENTS WITH RENAL TRANSPLANTATION

对１０８９例患者行１１１４次同种异体肾移植术，其中１７８例进行了组织学及免疫组织化学的研究，发现：①环孢霉素Ａ（ＣｓＡ）肾中毒占１０例；②光镜下可见近曲肾小管上皮明显浊肿，管腔明显变窄，上皮细胞颗粒变性，部分可见间质小动脉玻璃样变性；③电镜下可见近曲小管上皮细胞线粒体肿胀，呈极度扩大的球形。但肾小管基底膜清晰规则，电子密度均匀。结果表明：①肾近曲小管是肾单位中对ＣｓＡ肾中毒最为敏感的部位；②ＣｓＡ肾中毒可造成肾小管上皮细胞空泡变性，线粒体高度扩张，可能与线粒体Ｃａ２＋的内流有关；③ＣｓＡ肾中毒后肾小管基底膜保持完整，为肾小管上皮细胞的再生和恢复提供了条件；④应重视ＣｓＡ肾中毒与排斥反应时变性坏死的肾小管相区别。

The mechanism of CsA nephrotoxicity and its changes of pathologic morphology were evaluated in this study. The renal grafts of 178 cases were studied by light microscopy and immunohistochemistry. CsA nephrotoxicity account for 562%(10 cases).It was found that the proximal convoluted, degenerated and became necrosis in the samples of CsA nephrotoxicity. Some little arteries of the mesenchyme convoluted hyaline degeneration under light microscopy. The mitochodria of the proximal epithelial cells convoluted swollen, and were extremely enlarged in shape under transmission electron microscope. But the basement membrane of the uriniferous tubules still remained normal. It was coucluded that the most sensitive site of CsA nephrotoxicity be the proximal of the renal graft. CsA nephrotoxicity resulted in vacuole's degeneration of the proximal and extremely enlarged mitochodria might be related to the influx of Ca2+. It was suggested that the clinical and pathological changes of CsA nephrotoxicity and the degeneration and necrosis of the uriniferous tubules of rejection be paid direct attention.