176例移植供肾零点活检标本的病理分析  

Pathological analysis of time-zero renal biopsy in donor kidney

作　　者：李平 涂义姚 梁少姗 徐峰 梁丹丹 陈劲松 刘志红 曾彩虹 Li Ping;Tu Yiyao;Liang Shaoshan;Xu Feng;Liang Dandan;Chen Jingsong;Liu Zhihong;Zeng Caihong(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Medical School of Nanjing University,Nanjing 210016,China)

机构地区：[1]东部战区总医院,国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016

出　　处：《中华器官移植杂志》2019年第6期355-360,共6页Chinese Journal of Organ Transplantation

基　　金：江苏省医学重点人才项目(编号ZDRCA2016098).

摘　　要：目的总结移植供肾零点活检(time-zero renal biopsy,T0-RBx)标本的病理概况。方法回顾性分析东部战区总医院2008年3月至2016年5月间176例T0-RBx标本的取材质量和病理表现。根据供肾来源分为亲属活体供肾组(LD)137例、死亡后器官捐献组(DD)39例。DD组根据供者死因分为脑血管疾病组和脑外伤组。分析各组供肾病理结果及对移植肾功能的影响。结果T0-RBx标本均含皮质肾组织,光镜组织长度为(0.39±0.23)cm,肾小球数的中位数为11个。异常病变包括球性硬化(GS,30.7%)、节段硬化(1.1%)、系膜增生(MI,19.3%)、肾小管萎缩(TA,35.2%)、急性肾小管坏死(ATN,9.1%)、小管上皮细胞空泡变性(27.3%)、小管上皮细胞刷状缘脱落(97.7%)、蛋白管型(25%)、间质纤维化(IF,34.1%)、间质炎细胞浸润(I,42.6%)、动脉透明变性(AH,26.1%)和动脉内膜增厚(CV,23.3%)。确诊IgA肾病、免疫复合物相关肾小球疾病、局灶节段性肾小球硬化、糖尿病肾病分别有23.9%、1.1%、0.55%、0.55%,其余以缺血损伤为主。DD组TA、IF和I发生率低于LD组(P<0.05),但ATN、小管上皮细胞空泡变性发生率高于LD组(P<0.001),且脑血管疾病组GS发生率高于脑外伤组,差异有统计学意义(P<0.01),其余供肾病变差异无统计学意义(P>0.05)。GS与LD、DD组术后6、12个月移植肾功能均相关(P<0.05),IF、AH也分别与两组术后早期移植肾功能相关(P<0.05)。结论T0-RBx可发现供肾异常病变,不同供肾来源间存在差异,LD易出现TA和IF等慢性病变,而DD易发生急性肾小管间质损伤,对术后移植肾功能具有一定预测价值,而取材质量是结果可靠的关键。Objective To summarize the pathological survey of time-zero renal biopsy(T0-RBx).Methods The material qualities and pathological features were analyzed retrospectively for T0-RBx(n=176)between March 2008 and May 2016.According to the source of donor kidney,T0-RBx specimens were divided into living donors(LD)group(n=137)and Deceased donation(DD)group(n=39).Furthermore,the DD group was divided into cerebral hemorrhage group(n=10)and brain trauma group(n=29)according to the causes of death.The inter-group differences of pathological characteristics and the effects of abnormal pathological lesions on allograft function were observed.Results All T0-RBx specimens contained cortical kidney tissue.The average microscopic length of renal tissue was(0.39±0.23)cm and the median glomerular number 11.The abnormal pathological lesions included glomerulosclerosis(GS,30.7%),segmental glomerulosclerosis(1.1%),mesangial increase(MI,19.3%),tubular atrophy(TA,35.2%),acute tubular necrosis(ATN,9.1%),vacuolar degeneration of tubular epithelium(27.3%),losses in tubule epithelial brush border(97.7%),protein cast(25%),interstitial fibrosis(IF,34.1%),inflammation(I,42.6%),arteriolar hyalinosis(AH)(26.1%)and vascular fibrous intimal thickening(CV,23.3%).Among them,23.9%,1.1%,0.55%and 0.55%cases were diagnosed as IgA nephropathy,immune complex associated with glomerular disease and focal segmental glomerulosclerosis diabetic nephropathy respectively.And the reminders were of ischemic injury.The incidence rates of TA,IF and I were lower in DD group than those in LD group(P<0.05).However,ATN and vacuolar degeneration of tubular epithelium were higher(P<0.001).The incidence of GS was significantly higher in cerebral hemorrhage group than that in brain trauma group(P<0.01).No statistical difference existed in other lesions or disease constitution among the groups(P>0.05).Further analysis showed GS was related with allograft function at 6/12 months post-transplantation in both LD and DD groups(P<0.05).IF and AH were also related to short-term r

关 键 词：肾移植 亲属活体供者 细针抽吸活检 死亡后器官捐献 

分 类 号：R699.2[医药卫生—泌尿科学]