74例无功能移植肾的临床病理研究  

Clinical pathological studies of 74 failed renal allografts

作　　者：赵海潞[1] 游联璧[1] 李洪芬[1] 韦立新[1] 昝世明 程有权[1] 于占洋[1] 曾木英[1] 

机构地区：[1]解放军总医院病理科

出　　处：《中华器官移植杂志》1999年第1期33-36,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨移植肾失功的原因和移植肾血管病（ＡＲＡ）的发生机理。方法对７４例切除的无功能移植肾进行了临床病理分析，并应用免疫组织化学、免疫金电镜分别观察了２４例和５例发生ＡＲＡ的移植肾的形态。结果７４例无功能肾中急性排斥反应（ＡＲ）占８９．２％（６６／７４），慢性排斥反应（ＣＲ）占３６．５％（２７／７４）。ＡＲＡ的特征性形态为移植肾内动脉内膜呈向心性纤维性增厚，其中可见以Ｔ淋巴细胞为主的炎性细胞浸润；内皮细胞增生、肥大，并异常表达Ⅱ类主要组织相容性抗原（ＨＬＡＤ）。结论ＡＲ是造成移植肾无功能的最常见原因；ＡＲＡ是ＣＲ的特征性病变。Objective To investigate the causes leading the failure of kidney transplantation and the pathogenesis of arteriopathy of renal allograft (ARA). Methods Clinical pathological studies were retrospectively performed on 74 cases of failed renal allografts. Among the 74 cases, 24 and 5 of ARA underwent the morphological observation on the renal allografts by immunohistochemistry and under a immunogold electron microscope, respectively.Results In 74 cases of failed renal allografts, acute rejection(AR) occurred in 66 cases ( 89.2% ) and chronic rejection(CR) in 27 cases ( 36.5% ). The morphological characteristics in ARA included intimal fibrous proliferation with predominamt T lymphocyte infiltration. The vascular endothelial cells were hypertrophy and had the abnormal expression of class Ⅱ HLA D. Conclusion AR might be the most common causes resulting in the failed renal allografts. ARA was a characteristic lesion and might be an endothelialitis triggered by endothelial injury and mediated by T lymphocytes.

关 键 词：移植肾 移植物排斥 动脉内膜炎 病理 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]