773例移植肾组织活检的临床病理分析  

Clinicopathologic analysis of 773 renal allograft biopsies

作　　者：刘丁[1] 陈传宝[2] 孙光曦[1] 徐小龙[1] 雷学智[1] 刘永光[1] 郭颖[1] 赵明[1] 

机构地区：[1]南方医科大学珠江医院移植中心,广州510282 [2]中山大学附属第一医院东院器官移植中心,广州510700

出　　处：《重庆医学》2016年第12期1587-1590,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81170696)

摘　　要：目的总结南方医科大学珠江医院移植中心移植肾组织穿刺活检的穿刺指征及病理学类型和特点,评价移植肾组织活检的安全性及诊断价值。方法回顾性分析南方医科大学珠江医院2005年1月至2014年6月629位患者共773例移植肾穿刺活检资料。结果肾穿刺成功率100%,术后移植肾周小血肿9例(1.2%),肉眼血尿33例(4.3%),腹痛1例(0.13%)。穿刺指征:单纯蛋白尿205例(26.5%),不明原因的血肌酐升高187例(24.2%),蛋白尿合并血肌酐升高313例(40.5%),肾移植术后无尿/少尿53例(6.9%),程序性肾组织活检15例(1.9%)。病理类型:正常21例(2.7%);T细胞介导的急性排斥反应179例(23.2%),抗体介导的急性排斥反应51例(6.6%);T细胞介导的慢性排斥反应205例(26.5%),抗体介导的慢性排斥反应43例(5.6%);钙调神经磷酸酶抑制剂(CNI)药物中毒41例(5.3%),急性肾小管坏死29例(3.7%);复发/新发性的肾病11例(1.4%);乙型肝炎相关性肾病(HBVGN)9例(1.2%);临界性病变39例(5.0%);其他145例(18.8%)。结论移植肾活检安全性高,对肾移植术后肾疾病的病因诊断有重要的意义,能指导临床治疗并改善移植肾长期存活,临床中应常规开展。Objective To summarize the puncture indications and the pathological type features of renal allografts biopsies in our center for evaluating its safety and diagnostic value.Methods The data of 773 percutaneous renal allograft biopsies in 629 kidney transplants in the Pearl River Hospital of Southern Medical University from January 2005 to June 2014 were retrospectively analyzed.Results The success rate of renal biopsy was 100%,9cases（1.2%）were complicated postoperative perirenal small hematoma,33cases（4.3%）with gross hematuria and 1case（0.13%）with abdominal pain.Among the indications of 773 biopsies,protein urine occured 205cases（26.5%）of patient,blood Cr increased in 187cases（24.2%）of patients,protein urine simultaneously complicating blood Cr increased,in 313 cases of patients,53cases（6.9%）had postoperative oliguria urinary,and 15cases（1.9%）were get procedural biopsy.In the pathological types,21cases（2.7%）were normal,179cases（23.2%）were acute T cell-mediated rejection after transplantation,51cases（6.6%）were acute antibody-mediated rejection,205cases（26.5%）were chronic T cell-mediated rejection and 43cases（5.6%）were chronic antibody-mediated rejection;41cases（5.3%）were drug toxicity,29cases（3.7%）were acute tubular necrosis（ATN）,11cases（1.4%）were relapsed or new nephropathy;9cases（1.2%）were HBV related renal disease;39cases（5.0%）were critical lesion and 145cases（18.8%）were others.Conclusion Rrenal allograft biopsy is safe,it is important to the etiological diagnosis of renal disease after renal transplant,which can guide the clinical treatment and improve the long term survival of renal graft and should be routinely carried out in clinic.

关 键 词：肾移植 活组织检查 病理学 

分 类 号：R699.2[医药卫生—泌尿科学]