肾移植术后穿刺活组织检查分类应用进展

Application progress in classification of puncture biopsy after kidney transplantation

移植肾活组织检查(活检)依然是诊断移植术后肾功能异常的“金标准”。肾移植术后穿刺活检依据患者肾功能分为指示性活检及程序性活检。指示性活检主要用于诊断肾移植并发症、判断病情严重程度并指导后续治疗;程序性活检主要用于定期监测肾移植受者移植肾功能,以排除亚临床排斥反应等并发症。因患者意愿等原因,程序性活检在我国未能广泛应用,指示性活检是现今主要的活检方式。目前指示性活检穿刺指征、程序性活检穿刺时机及必要性仍存在争议。本文对肾移植术后穿刺活检分类、基于活检的组织生物标志物研究进展进行综述,旨在为协助临床进行肾移植术后并发症的明确诊断和针对性治疗,进一步提高移植肾和受者的良好存活提供参考依据。

Renal allograft biopsy(biopsy)remains the"gold standard"for the diagnosis of renal dysfunction after kidney transplantation.Puncture biopsy after kidney transplantation could be divided into indicative biopsy and protocol biopsy according to renal function of the patients.Indicative biopsy is mainly applied to diagnose postoperative complications of kidney transplantation,evaluate the severity of disease and guide subsequent treatment.Protocol biopsy is primarily employed to regular monitor renal allograft function of kidney transplant recipients and exclude subclinical rejection and other complications.Due to the willingness of patients and other reasons,protocol biopsy has not been widely applied in China.Currently,indicative biopsy is the main biopsy pattern.At present,the indications of puncture of indicative biopsy,the timing and necessity of puncture of protocol biopsy remain controversial.In this article,the classification of puncture biopsy after kidney transplantation and research progress on tissue biomarkers based on biopsy were reviewed,aiming to assist clinical diagnosis and targeted treatment of complications after kidney transplantation and provide reference for further improving the survival of renal allografts and recipients.