移植后慢性肾损害的病理及临床分析

CLINICAL AND PATHOLOGICAL ANALYSIS OF CHRONIC RENAL ALLOGRAFT DYSFUNCTION

目的 :了解移植后慢性肾损害的病理类型及可能诱发的原因。 方法 :回顾分析解放军肾脏病研究所 1985年 3月至 1999年 6月因移植后慢性肾脏损害行肾活检的 97例肾移植患者。 结果 :移植后慢性肾脏损害的病理类型以慢性排斥 (慢排 )最多 77例 (79 4% ) ,系膜病变 11例 (11 3% ) ,新月体肾炎 3例 (3 1% ) ,膜性肾病2例 (2 1% ) ,IgA肾病 2例 (2 1% ) ,溶血性尿毒综合征 2例 (2 1% )。高血压的发生率为 71 1% ,蛋白尿 6 8 0 % ,镜下血尿占 15 5 % ;78 3%的患者肾功能减退。对比慢排与非慢排组患者的临床表现和实验室检查结果 ,发现二组在供肾年龄 (分别为 33 4± 6 2岁和 2 6 8± 5 3岁 ) ,急性排斥 (急排 )发生率 (46 7%和 2 7 2 % ) ,移植肾功能延迟恢复 (DGF)发生率 (16 9%和 6 0 % ) ,肾外结核感染率 (5 41%和 1 6 3% )及高血压发生率 (70 1%和 6 1 4% )均有显著性差异 (P <0 0 1) ,蛋白尿 (83 1%和 13 9% )及肾组织巨细胞病毒 (CMV)感染阳性率 (13 0 9%和 1 36 % )差异极显著 (P <0 0 0 1)。 结论 :移植后慢性肾脏损害最常见的病理类型仍为慢排。与慢排相关的因素可能包括 :供肾年龄 ,急排发生率 ,DGF及CMV感染。高血压和蛋白尿对移植肾的远期预后也有重要影响。

To investigate the histologic and clinical risk factors associated with chronic renal allograft dysfunction(CRAD) in renal allograft recipients. METHODOLOGY A retrospective analysis was performed in 97 renal allograft recipients with CRAD confirmed by renal graft biopsy.368 recipients without CRAD were used as the control group for analysis of clinical risk factor for CRAD. RESULTS Among the 97 recipients,77(79 4%) were classified as chronic rejection,11(11 3%)as mesangial lesion,3(3 1%)as crescentic nephritis,2(2 1%)as membranous nephropathy,2(2 1%)as IgA nephropathy and 2(2 1%)as hemolytic uremic syndrome.Clinically,in these patients with CRAD,the frequencies of hypertension,proteinuria,microscopic hematuria and renal allograft dysfunction were 71 2%,68 0%,15 5%,78 3% respectively.In analysis of clinical risk factors for CRAD,significant differences were found in donors age(33 4±6 2 vs 26 8±5 3 years, P <0 01),frequencies of acute rejection(46 7% vs 27 2%, P <0 01),positive rates of renal graft CMV detection(13 09% vs 1 36%, P <0 001),the rates of tuberculosis (10 4% vs 4 9%, P <0 01)and herpes zoster(5 41% vs 1 63%, P <0 01)infections,the frequencies of proteinuria(83 1% vs 13 9%, P <0 001)and hypertension(70 1% vs 61 4%, P <0 01). CONCLUSION The most frequent pathological type of CRAD was chronic rejection.Risk factors associated with CRAD included:donors age,previous acute rejection,infection with CMV or TB or herpes zoster virus.Hypertension and proteinuria were interwoven in the development of chronic rejection.