活检取材部位和方法对公民逝世后器官捐献供肾组织病理学评估的影响

Effect of biopsy location and method on histopathological evaluation of donation after citizen's death donor kidney

目的探究不同取材部位和取材方法对公民逝世后器官捐献(donation after citizen's death,DCD)供肾组织病理学评估的影响。方法收集2019—2022年华中科技大学同济医学院附属同济医院器官移植研究所的10例弃用供肾标本。于肾脏不同位置获取活检标本,经石蜡切片及苏木精-伊红染色后比较其肾小球和小动脉数量及其病变程度,并根据Banff评分、Remuzzi评分、Maryland评分以及Pirani评分对样本进行模拟评估。然后将标本与获取时穿刺活检标本进行对比,并计算2种标本单位面积中肾小球和小动脉数量。结果不同部位取材的标本中可观察到的肾小球和小动脉数量及病变程度没有差异(P>0.05),模拟Banff评分、Remuzzi评分、Maryland评分以及Pirani评分均没有显著性差异(P>0.05)。穿刺标本的肾小球硬化率(42%±8.8%比25%±23.2%)、小动脉内膜增厚比例(68%±27%比46.5%±22.8%)和小动脉透明样变比例(86%±17.4%比59.3%±16.4%)高于解剖标本。两种标本的供肾评分仅Banff评分中的肾小球硬化程度具有显著性差异(2.2±0.4比1.6±0.9),其余评分没有显著性差异(P>0.05)。在单位面积下穿刺标本的肾小球数量小于解剖标本〔(199.3±50.7)个/cm^(2)比(240.6±57.4)个/cm^(2)〕,但是小动脉数量大于解剖标本〔(153.5±76.9)个/cm^(2)比(114.9±43.7)个/cm^(2)〕。结论从不同部位获取活检标本对DCD供肾组织学评估没有影响。穿刺活检标本评分结果可以反映供肾病理损伤程度。目前穿刺活检较深,穿刺时应适当减小进针角度。

Objective To explore the effects of different biopsy location and methods on the histopathological evaluation of donation after citizen's death(DCD)donor kidney.Methods Ten cases of discarded donor kidneys were collected from 2019 to 2022.Samples were harvested from different sites and prepared by paraffin section.After being stained with hematoxylin-eosin(HE),the number of glomeruli and arterioles and the degree of lesion were compared.The specimens were evaluated according to Banff score,Remuzzi score,Maryland score and Pirani score.The samples were compared with the other samples collected bycore needle biopsy,and the number of glomeruli and arterioles per unit area of the two samples were calculated.Results There was no difference in the number and degree of glomeruli and arterioles observed in specimens taken from different parts(P>0.05),and there was no significant difference in Banff score,Remuzzi score,Maryland score and Pirani score(P>0.05).The proportion of glomerulosclerosis(42%±8.8%vs.25%±23.2%),intimal thickening of arterioles(68%±27%vs.46.5%±22.8%)and arterioles hyaline degeneration(86%±17.4%vs.59.3%±16.4%)in core needle biopsy specimens was higher than that in anatomical specimens.In the aspect of donor kidney scoring,only the degree of glomerulosclerosis in Banff score was significantly different between the two samples(2.2±0.4 vs.1.6±0.9),and there was no significant difference in other scoring systems(P>0.05).The number of glomeruli in core needle biopsy specimens per unit area was less than that in anatomical specimens〔(199.3±50.7)/cm^(2) vs.(240.6±57.4)/cm^(2)〕,but the number of arterioles was greater than that in anatomical specimens〔(153.5±76.9)/cm^(2) vs.(114.9±43.7)/cm^(2)〕.Conclusion The way of obtaining biopsy specimens from different parts had no effect on the histological evaluation of DCD donor kidney.The scoring results of core needle biopsy specimens can reflect the degree of donor kidney lesions.The sample getting from core needle biopsy is deep,and the degree of angle entering the donor kidney should be appropriately decreased.