脑死亡供体肺脏病理改变及临床移植应用前景探讨

Evaluation of the lung pathology in donor with brain-death and the feasibility using the lung for transplantation

目的观察脑死亡供体肺病理改变,探讨临床移植应用的可行性。方法对23例脑死亡供体肺进行了病理活检,HE染色、网状纤维染色及PASM染色观察肺脏组织变化,电镜观察超微结构变化。结果气管、支气管及肺泡结构尚完整,仅见局灶肺泡上皮细胞及支气管纤毛上皮细胞脱落,未见肺透明膜形成;肺泡间隔未见明显增宽、血管充血易见,血管内皮细胞未见明显改变,未见纤维化表现。电镜下肺泡Ⅱ型上皮细胞胞质轻微水肿,但结构尚完整;内质网扩张,基底膜未见明显改变。结论严格限定纳入标准,脑死亡供肺可以实施移植。

Objective To evaluate the feasibility of using the lung from donor with brain-death for transplantation.Methods Histopathologic biopsies were obtained from 23 pulmonary donors with brain death.Pathological examination was performed after staining of the lung tissues with HE,reticular fiber and PASM stain.The microstructure of lung tissues was observed under an electron microscope（EM）.Results Microscopic examination revealed that the tracheal,bronchial and alveolar structures were intact,with some alveolar endothelial cell and bronchial ciliary cell loss.Hyaline-membrane formation,thickening of the alveolar septum,changes of endothelial cell and fibrosis were not observed,but the congestion in blood vessel was seen.EM micrographs showed that type-II epithelia of alveolus had slightly edematous,but the structure was complete.Dilation of rough endoplasmic reticulum was seen and changes of basal membrane were not obvious.Conclusion Brain death donor is suitable for pulmonary transplantation.