供肾零点活检对中老年公民逝世器官捐献供肾的评价  

The significance of time-zero renal biopsy on evaluating transplantation from donation after cardiac death in old aged donors

作　　者：李金锋[1] 孙佳佳[1] 丰贵文[1] 尚文俊[1] 庞新路[1] 刘磊[1] 谢红昌[1] 

机构地区：[1]郑州大学第一附属医院肾移植科,450052

出　　处：《中华老年医学杂志》2018年第3期306-310,共5页Chinese Journal of Geriatrics

基　　金：河南省教育厅高等学校重点科研项目（18A320041）;河南省医学科技攻关计划项目（201702024）

摘　　要：目的探讨供肾零点活检对中老年公民逝世后器官捐献供肾的评价。方法回顾性分析2016年8月至2017年4月我院完成的112例公民逝世器官捐献供肾零点穿刺病理资料及供、受者临床资料，依据供者年龄以及零点肾活检Remuzzi评分分组：（1）供者年龄〈50岁（0～3分）组58例；（2）年龄〈50岁（4～6分）9例；（3）年龄≥50岁（0～3分）组35例；（4）年龄≥50岁（4～6分）组10例。比较各组受者早期移植肾功能及术后并发症发生率。结果受者术后6个月估算的。肾小球滤过率与肾小球硬化率、小动脉玻璃样变、动脉内膜纤维化呈负相关（r值分别为-0．398、-0．416、-0．242，均P〈0．05）；小动脉玻璃样变（β=-0．249，P〈0．05）、动脉内膜纤维化（β=-0．246，P〈0．05）是术后6个月肾小球滤过率的独立相关因素。≥50岁（4～6分）组受者术后各时间点血肌酐高于其他3组（均P〈0．05）；肾小球滤过率低于其他3组（均P〈0．05）。供者年龄≥50岁组术后6个月内急性排斥反应发生率高于〈50岁组（P〈0．05）。术后6个月内移植肾功能延迟恢复、血尿、蛋白尿的发生率4组的受者比较，差异无统计学意义。结论伴有中度组织学病变的中老年供肾术后早期的受者肾功能恢复相对较慢，同时应用中老年供肾受者术后急性排斥反应发生率较高，此类供肾的受者选择及术后免疫抑制方案应当更为严谨。Objective To explore the significance of time-zero renal biopsy on evaluating renal function and postoperative complications after transplantation from donation in old age donors. Methods Clinical and pathological data of 112 transplantations with time-zero renal biopsy which performed in the First Affiliated Hospital of Zhengzhou Hospital from August 2016 to April 2017 were collected. Based on donor age and Remuzzi score, 112 transplantations were divided into four groups： Group A （donor age （50 years and Remuzzi score is 0 to 3） with 58 recipients, Group B （donor age （50 years and score is 4 to 6） with 9 recipients, Group C （donor age≥50 years and score is 0 to 3） with 35 recipients, and Group D （donor age≥50 years and score is 4 to 60） with 10 recipients. Renal function and postoperative complications of recipients in each group were recorded and compared among groups. Results The estimated glomerular filtration rate （eGFR） at 6th month after operation was significantly negatively correlated with glomerular sclerosis （r= -0. 398, P= 0.05）, arteriolar hyaline degeneration （r=-0. 416, P〈0.05） and arterial intimal fibrosis （r= - 0. 242, P〈0.05）. Arteriolar hyaline degeneration （β=-0. 249, P〈0.05） and arterial intimal fibrosis （β=- 0. 246, P= 0.020） were the independent correlated factors of eGFR at 6th month after operation. The levels of serum creatinine of group D were higher than those in the other three groups at each time after operation（all P〈0.05）;Moreover,in group D the eGFR values at each time were lower than those in the other three groups（P〈0.05）. Additionally, the incidences of acute rejection within 6 months after operation in group C and D were higher than those in group A and B （all P〈 0.05）, but the incidences of delayed graft function, hematuria, proteinuria among four groups werenot significantly different （all P〉0.05）. Conclusions Patients who accepted older kidney with moderate histological lesions show worse ren

关 键 词：组织供者 组织检查 针吸 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]