供肾移植前病理结果与移植后短期肾功能的关系  

Relationship between pre-transplantation kidney biopsy andshort-term renal function after transplantation[AbstractJObjective

作　　者：夏秋翔 王淼 李恒[1] 刘静[1] 郭琛 李博 张晖 谢飞 范磊 朱红艳[1] 苏华[1] 王振迪 Xia Qiuxiang;Wang Miao;Li Heng;Liu Jing;Guo Chen;Li Bo;Zhang Hui;Xie Fei;Fan Lei;Zhu Hongyan;Su Hua;Wang Zhendi(Department of Urology, Union Hospital, Affiliated Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430014, China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430014

出　　处：《中华器官移植杂志》2019年第4期231-236,共6页Chinese Journal of Organ Transplantation

摘　　要：目的分析及讨论供肾移植前穿刺病检结果与移植术后短期肾功能恢复情况的关系。方法回顾性分析我院2016年7月至2018年4月间240个供肾移植前穿刺病理检査及受者住院期间临床资料,根据2016年供肾Banff评分对供肾进行病理学评估。分析病理结果与移植术后短期肾功能恢复情况的关系。结果肾小球硬化率与移植肾功能延迟恢复(DGF)发生无显著相关性(P =0. 815),与1周估算肾小球滤过率(eGFR)及出院eGFR显著性相关(P<0. 05),但肾小球硬化率V20%(220例)与豪20%(20例)组,两组间DGF、1周eGFR、出院eGFR的差异无统计学意义(P>0.05)。动脉内膜纤维化与DGF情况显著正相关,与1周eGFR和出院eGFR显著负相关(P<0.05),动脉内膜纤维化评分<2(199例)与≥2(41例)组,两组间1周eGFR、出院eGFR差异有统计学意义(P<0.05)。小动脉玻璃样变程度与1周eGFR和出院eGFR显著负相关(P<0. 05),小动脉玻璃样变评分<2(193例)与≥2(47例)组,两组间DGF情况、1周eGFR和出院eGFR差异有统计学意义(P<O. 05);Remuzzi评分与1周eGFR和出院eGFR显著负相关(P<0. 05)。Remuzzi评分<4(183例)与≥4(57例)组,两组间DGF情况、1周eGFR、出院eGFR差异有统计学意义(P<0.05)。间质纤维化程度与DGF情况显著正相关(P<0. 05),与1周eGFR和出院eGFR显著负相关(P<0.05),间质纤维化评分0分组(215例)和1-3分组(25例)两组间DGF、1周eGFR和出院eGFR差异有统计学意义(P<0.05)。结论供者肾小球硬化率影响受者术后早期移植肾功能,但20%作为阈值判断早期功能的意义有限。动脉内膜纤维化和小动脉玻璃样变是影响术后早期GFR的重要因素。Remuzzi评分4分以上者移植后短期移植肾功能较差。间质纤维化评分是否可作为术后DGF和短期肾功能恢复的预测因素,希望能有更多文献研究讨论。Objective To explore the correlation between pre-transplantation donor kidney biopsy and short-term renal function after transplantation.Methods This study include 240 kidney transplantation of donation after cardiac death(DCD)from July 2016 to April 2018.Banff's score of donor kidney biopsy was employed for estimating kidney status.Results No significant correlation existed between rate of glomerulosclerosis and delayed graft function(DGF)(P=0.815).The rate of glomerulosclerosis was significantly correlated with 1-week estimated glomerular filtration rate(eGFR)and discharge eGFR(P<0.05).Based upon the glomerulosclerosis rate,the patients were divided into two groups <20%(n=220)and ≥20%(n=20),there was no significant inter-group difference in DGF,1-week eGFR or discharge eGFR(P>0.05).Arterial fibrosis was significantly positively correlated with DGF and negatively with 1-week eGFR and discharge eGFR(P<0.05).Statistically significant inter-group differences existed in 1-week eGFR and discharge eGFR that arterial fibrosis scores<C 2(n=19)and ≥2(n=41)(P<0.05).Arteriolar hyalinosis score was negatively correlated with 1-week eGFR and discharge eGFR(P<0.05).Based upon arteriolar hyalinosis scores,they were divided into two groups<C 2(n=193)and ≥2(n=47).There were significant inter-group differences in DGF,1-week eGFR and discharge eGFR(P<0.05).Remuzzi scores were negatively correlated with 1-week eGFR and discharge eGFR(P<0.05).Interstitial fibrosis was significantly postiively correlated with DGF(P<0.05)and negatively with 1-week eGFR and discharge eGFR(P<O.05).Conclusions Donor kidney glomerulosclerosis rate affects short-term renal function of recipients after transplantation.However,using 20%as a threshold value is limited in clinical practice.Arterial intimal fibrosis and arteriolar hyalinosis are important factors affecting short-term eGFR.Recipient kidneys with Remuzzi score>4 had poor renal function after transplantation.Interstitial fibrosis score may be used as a predictor of postoperative DGF and shor

关 键 词：肾移植 肾穿刺活检 移植肾功能延迟 

分 类 号：R699.2[医药卫生—泌尿科学]