肝移植术后急性排异的病理类型与转归:附1120例次肝穿刺分析  

Clinicopathological classifications and significance of acute rejection after liver transplantation:an analysis on 1120 liver biopsies

作　　者：丛文铭[1] 陆新元[1] 董辉[1] 夏春燕[2] 赵骞[1] 

机构地区：[1]第二军医大学东方肝胆外科医院病理科,上海200438 [2]第二军医大学长征医院病理科,上海200003

出　　处：《临床与实验病理学杂志》2011年第2期117-120,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨肝移植(liver transplantation,LT)术后急性排异反应(acute rejection,AR)的临床和病理学类型及其转归特点。方法回顾性分析2003年7月～2010年6月期间诊断的624例/1 120例次LT术后肝穿刺活检病例,重点观察AR病例在发生时机和组织学类型上的差异。结果 AR检出率为21.8%(n=244),其中汇管区型AR(PB-AR)和伴或不伴PB-AR的中央静脉周围炎型AR(CP-AR)分别占79.9%和20.1%;早期AR(≤1月)、中期AR(1～6月)和迟发性AR(>6月,LAR)分别占60.7%、23.3%和16%。38.1%的早期CP-AR与PB-AR伴随出现,而84.2%的迟发性CP-AR为孤立性病变。交界性AR在组织学类型和发生时间上均呈现出与AR相似的分布趋势。结论 PB-AR和CP-AR分别在LT术后早期和晚期发生为主,可能反映了不同的免疫排异机制;与PB-AR相比,CP-AR或LAR具有对免疫抑制剂抵抗性和病变易残留的特点。因此,在病理诊断时应注意描述AR的组织学分型特点,临床上需重视对此类AR患者免疫抑制治疗后进行适时肝穿刺活检随访。Purpose To investigate the clinicopathological types of acute rejection（AR） and their clinical significance after liver transplantation（LT）.Methods A retrospective clinicopathological study was made on differences in the timing of occurrence and histological types of AR based on 1120 liver allograft biopsies from 624 patients during a 7-year-period between July 2003 and June 2010.Results The incidence of AR was 21.8%（n=244）,of which portal-based AR（PB-AR）and central perivenulitis-based AR（CP-AR）with or without PB-AR accounted for 79.9% and 20.1%,and early（≤1 month）,medium（1~6 months）and late（6 months,LAR）AR accounted for 60.7%,23.3% and 16%,respectively.Of the early CP-AR,38.1% were accompanied with PB-AR,whereas 84.2% late CP-AR were isolated lesions.Borderline AR showed similar distribution trend with AR in both histological types and the timing of occurrence.Conclusions PB-AR and CP-AR tends to occur in the early-and late-stage after LT,respectively,suggesting differences in the AR mechanism.CP-AR or LAR should be considered as a unique entity of AR due to their refractory to immunosuppression therapy.Therefore,more attention should be paid to the follow-up of liver biopsy after anti-AR treatment for CP-AR or LAR and to provide correct histological classification of AR for the clinic.

关 键 词：肝移植 肝穿刺 急性排异 迟发性急性排异 中央静脉周围炎 

分 类 号：R657.3[医药卫生—外科学]