移植肾活检在移植肾疾病早期诊断及鉴别诊断中的价值  

Role of biopsy of kidney allograft in early diagnosis and differential diagnosis of renal allograft diseases

作　　者：眭维国[1] 陈怀周[1] 邹和群[2] 晏强[1] 车文体[1] 邹贵勉[1] 谢申平[1] 

机构地区：[1]解放军第181医院全军肾移植与透析治疗中心,广西桂林541002 [2]中山大学附属第五医院肾脏科

出　　处：《解放军医学杂志》2008年第10期1198-1201,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨移植肾活检在移植肾急性排斥反应、慢性排斥反应、慢性环孢素肾病、肾小球肾炎等移植肾病变诊断及鉴别诊断中的价值,并探讨慢性排斥反应的早期肾活检时机。方法对肾移植受者中出现血清肌酐水平升高超过正常水平、微量白蛋白尿或（和）蛋白尿、肾小球性血尿等临床表现,但根据临床资料并不能确诊病因的44例实施非随机移植肾活检,另对6例受者于术后1个月进行常规移植肾活检。对全部肾活检标本依照Banff 97分类标准进行病理诊断,并结合临床资料进行分析。结果在移植后1年内、移植后2～3年、移植后3年以上分别接受肾活检的受者中慢性排斥反应发生率分别为31.3%、76.5%和88.2%,肾活检发现慢性排斥反应的移植受者中多数并无明显的慢性排斥临床表现。临床拟诊急性排斥的受者中,少数经移植肾活检排除急性排斥,多数病理检查虽证实为急性排斥,但其中部分受者同时合并慢性排斥、肾小球肾炎和环孢素肾病;临床拟诊为慢性排斥反应者均由肾活检后病理确诊,但其中少数受者同时存在急性排斥,肾小球肾炎和慢性环孢素肾病病理表现;移植肾损害病因不明的受者移植肾活检结果分别为急、慢性排斥、肾小球肾炎和慢性环孢素肾病。肾活检诊断为肾小球肾炎的受者中近半数并无肾小球肾炎临床证据。上述患者经肾活检明确诊断后,治疗效果良好。结论本研究结果提示,肾移植术后第2、3年是早期诊断慢性排斥反应的最佳时机,应该在术后第2、3年进行常规移植肾活检。移植肾活检对临床不能明确移植肾疾病诊断的肾移植受者具有重要作用,并有利于修正临床诊断。临床上常见移植肾同时存在急、慢性排斥反应,慢性环孢素肾病,肾小球肾炎等两种或两种以上疾病的情况。Objective To investigate the role of biopsy kidney allograft in the early diagnosis and differential diagnosis of acute and chronic rejection and other diseases involving renal allograft, and to determine the optimal time for early biopsy in chronic allograft rejection.Methods Non-random biopsy of renal allograft was performed in 44 kidney transplant recipients with the clinical manifestation of diagnosis-unconfimed allograft diseases, in the presence increased in serum creatinine, microalbuminuria or/and proteinuria, glomerular hematuria and so on. Another 6 kidney transplant recipients received routine allograft biopsy 1 month after operation. Pathological evaluation was performed in all sections according m Banff 97 classification and based on clinical data. Results Chronic allograft rejection was discovered in the renal allograft specimens of 31. 3%, 76. 5%0 and 88. 2% recipients, respectively, in the 1st year, the 2nd to 3rd year and over 3 years after operation, and most of them showed no obvious clinical manifestation. A part of recipients with clinical diagnosis of acute rejection also showed pathological manifestations of chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy. A part of recipients with clinical diagnosis of chronic rejection showed pathological manifestations of acute rejection and/or glomerulonephrifis and chronic cyclosporine nephropathy. Pathological features of acute or chronic rejection, glomerulonephritis and chronic cyclosporine nephropathy were observed respectively in recipients with disorders of kidney allograft with unknown diagnosis. No obvious clinical symptoms were observed in nearly half of the patients with pathological diagnosis of glomerulonephritis. Good therapeutic effect was obtained in these recipients who were correctly treated on the basis of definite pathological diagnosis. Conclusions h is indicated that optimal time for early diagnosis in chronic renal allograft rejection might be the 2nd and 3rd year after transplantation, and routine

关 键 词：肾移植 移植物排斥 活组织检查 针吸 肾 诊断 鉴别 

分 类 号：R446.8[医药卫生—诊断学] R447[医药卫生—临床医学]