移植肾穿刺活组织检查:72例的病理及临床分析

Pathological and clinical analysis of the kidney puncturation biopsy in 72 cases

背景:肾移植后慢性排斥反应及各种移植肾病变是移植肾失功能的常见原因,但对移植肾予以准确评估往往非常困难,活检仍是目前的主要手段。目的:分析肾移植后出现合并症时移植肾穿刺活检的病理结果。方法:对72例移植肾进行肾穿刺活组织检查,并进行病理诊断及分类,结合移植后情况进行分析。结果与结论:72例中发生急性细胞介导性排斥反应35例,急性抗体介导性排斥反应12例,移植肾急性药物毒性损伤10例,慢性T细胞介导性排斥反应6例,慢性抗体介导性排斥反应2例,急性肾小管坏死4例,慢性移植肾肾病3例。移植肾组织活检的病理报告与穿刺前临床诊断的符合率在75%以上。移植肾穿刺活检未发生明显的不良反应。提示移植肾活检安全可靠,对肾移植后难以根据临床化验资料作出准确判断肾脏损害的并发症及治疗方案的选择有极为重要的指导意义。

BACKGROUND： Chronic rejection after kidney transplantation and a variety of transplant nephropathy are the common causes of graft loss function, but, to assess the transplant kidney accurately is often very difficult, and biopsy is still the primary method currently. OBJECTIVE： To investigate the pathological results to diagnosis and treat of kidney puncturation biopsy for postoperative complications after the renal transplantation. METHODS： Seventy-two renal allograft biopsies were performed. Pathological diagnosis and classification was performed and the data was analyzed.TESULTS AND CONCLUSION： Among the 72 cases, 35 cases suffered from acute cell-mediated rejection, 12 cases suffered from acute antibody-mediated rejection, 10 cases suffered from renal allograft acute drug toxicity damage, 6 cases suffered from chronic T cell-mediated rejection, 2 cases suffered from chronic antibody-mediated rejection, 4 cases suffered from acute tubular necrosis, and 3 cases suffered from chronic allograft nephropathy. The coincidence between pathological replacement of nephridial tissue after transplantation and clinical diagnosis before puncturation was more than 75%. There was no visible adverse effect after the renal allograft biopsies. Renal graft biopsy is safe and reliable, which guiding significance to find complications of the kidney impaired after transplantation that are difficult to discover on the basis of clinical dates and to choose a more better treatment prescription.