移植肾活检病理和治疗效果117例分析

Analysis of the pathological feature and curative effect of 117 renal allograft biopsies

目的总结本中心移植肾活检的病理学类型、特点和治疗效果。方法回顾性分析本院2004年2月～2007年11月共117例移植肾穿刺活检的病理学资料。根据Banff97移植肾活检病理学诊断与分类方案，结合患者的病史和临床表现制定相应的治疗策略，并对治疗效果进行随访研究。结果117例移植肾穿刺活检标本的病理类型为：急性排斥反应共68例，占58．1％；慢性移植物肾病20例（17．1％）；临界性病变11例（9．4％）；CNI药物中毒4例（3．4％）；急性肾小管坏死3例（2.6％）；其他包括正常和无法确诊共11例（9．4％）。经治疗后，急性肾小管坏死和药物中毒的患者全部好转。11例临界性病变的患者，治疗有效率为81．8％。慢性移植物肾病的20例患者，治疗后15例（75％）好转。三个时间段急性排斥（0～3个月、3～12个月和大于12个月）的治疗有效率分别为57．1％、41．7％和75％。结论移植肾穿刺活检为临床治疗提供了可靠的依据。急性排斥仍然是影响移植肾功能的重要因素，并且不同时间段发生的急性排斥治疗效果存在差异。提高对临界性病变的认识并早期治疗可以达到很好的效果。

Objectives To investigate the pathological feature and curative effect of renal allograft biopsies in our center. Methods Our study included 117 histopathologic diagnoses of renal allograft biopsies performed in our center from Febroary 2004 to November 2007. According to the Banff （ 1997 ） classification, our treatment was corresponded to the history-and,clinical features of the patients, and we gave an integrated follow - up visit to the prognosis of all the patients. Results The analysis revealed 68 cases of acute rejection （58.1% ） , 20 cases of chronic alloraft nephropathy （17.1% ） , 11 cases of borderline change （9.4%）, 4 cases of nephrotoxicity （3.4%）, 3 biopsies of acute tubular necrosis（2.6% ）, normal morphology and unknown pathological classification（9.4% ）. The curative effect of all the cases of acute tubular necrosis and nephrotoxieity were gratified. The curative effective rate of the 11 borderline changes was 81.8%. The curative effective rate of 20 chronic allograft nephmpathy cases was 75 %, mean while, the acute rejection cases was 57.1% （0 - 3 months after transplantation） ,41.7% （3 - 12 months after transplantation） ,75% （ over 12 months after transplantation）. Conclusions Renal allograft biopsy reliably indicates the treatment of different pathology. Still, acute rejection is the major complication influencing the renal function after renal transplantation, while significant difference of the curative effects of acute rejection has been observed in different periods of time after the operation. Early diagnosis and treatment to borderline changes results in a satisfactory curative effect.