移植肾穿刺20例活组织病理检查的临床价值  

Percutaneous biopsy of renal allograft:Analysis of pathological and clinical value in 20 cases

作　　者：裴向克[1,2] 韩永[2] 王强[3] 许亮[2] 郭晖[3] 石炳毅[2] 蔡明[2] 

机构地区：[1]解放军第281医院泌尿外科,河北省秦皇岛市066100 [2]解放军第309医院全军器官移植中心,北京市100091 [3]华中科技大学同济医学院附属同济医院器官移植研究所,湖北省武汉市430030

出　　处：《中国组织工程研究》2012年第31期5737-5741,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:根据临床表现、无创性辅助检查及临床经验来判断肾移植后移植肾功能异常的原因常常会陷入困境,经皮肾穿刺活组织检查则可提供重要的循证学依据。目的:探讨移植肾穿刺活组织检查的临床意义。方法:回顾性分析20例移植肾穿刺活检病理资料及相应调整治疗后的临床结果资料。结果与结论:20例患者病理诊断为急性排斥反应7例(35%),可疑性急性排斥反应2例(10%),可疑性急性排斥反应加免疫抑制剂中毒1例(5%),免疫抑制剂中毒3例(15%),慢性移植肾肾病3例(15%),未见明确异常3例(15%),肾小管坏死1例(5%)。相应调整治疗方案后,移植肾功能恢复正常9例(45%),移植肾功能好转7例(35%),肾功能无明显变化3例(15%),肾功能轻度恶化1例(5%)。结果可见肾穿刺活组织检查对肾移植后肾功能异常的病因诊断有重要的价值,有利于指导治疗方案的调整。BACKGROUND： To determine the cause of graft renal dysfunction after renal transplantation based on the clinical manifestations, non-invasive examinations and clinical experience is often in trouble, percutaneous renal biopsy can provide important evidence-based theory. OBJECTIVE： To investigate the clinical significance of renal allograft biopsy. METHODS： Pathological data of 20 patients with renal allograft biopsy and the clinical outcome of accordingly adjusted treatment were retrospectively analyzed.RESULTS AND CONCLUSION： Acute rejection occurred in seven cases （35.0%）, doubtful acute rejection occurred in two cases （10.0%）, doubtful acute rejection combined drug poisoning occurred in one cases （5.0%）, drug poisoning occurred in three cases （15.0%）, chronic allograft nephropathy occurred in three cases （15.0 %）, no obvious abnormality occurred in three cases （15.0%）, acute renal tubular necrosis occurred in one case （5.0%）. After therapeutic regimen was adjusted, graft function of nine cases （45%） returned to normal, seven cases （35%） improved, three cases （15%） did not change markedly and one case （5%） deteriorated slightly. Renal graft biopsy is important for the etiological diagnosis of the graft function deterioration after kidney transplantation and is in favor of the adjustment of the therapeutic regimen.

关 键 词：肾移植 肾穿刺 病理诊断 肾功能异常 急性排斥反应 

分 类 号：R617[医药卫生—外科学]