移植心脏病理学诊断标准及其进展  

Diagnostic criteria and research progress on heart allograft pathology

作　　者：郭晖[1] Guo Hui(Organ Transplantation Institute,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation of Ministry of Education,Key Laboratory of Organ Transplantation of National Health Commission of China,Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030

出　　处：《器官移植》2021年第6期662-675,共14页Organ Transplantation

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2019PT320014)。

摘　　要：随着心脏移植外科技术的提高和强效免疫抑制剂的临床应用,心脏移植例数和移植心脏存活时间均显著提升。然而在心脏移植术后的不同阶段,仍然可出现移植心脏右心室衰竭、缺血-再灌注损伤、急性排斥反应、“Quilty病变”、感染和以移植心脏冠状动脉血管病(TCAD)为特征的慢性排斥反应等一系列并发症。心内膜心肌活组织检查(EMB)技术的应用使得包括排斥反应在内的移植心脏多种并发症的病理学特征得以观察和掌握,并成为移植心脏并发症最为准确的诊断手段。本文对移植心脏病理学研究的简史、心脏移植术后主要并发症及其诊断标准以及移植心脏排斥反应诊断研究的最新进展进行阐述,旨在使更多的心脏移植受者受益。With the improvement of surgical technique of heart transplantation and clinical application of potent immunosuppressant,the quantity of heart transplantation and the survival time of heart allograft have been significantly improved.However,a series of complications,such as right ventricular failure,ischemia-reperfusion injury,acute rejection,"Quilty lesion",infection and chronic rejection characterized by transplant coronary artery disease(TCAD)may still occur at different stages after heart transplantation.The application of endomyocardial biopsy(EMB)makes it possible to observe and understand the pathological features of multiple complications of heart allograft including rejection,which has become the most accurate diagnostic tool for postoperative complications.In this article,the brief history of heart allograft pathology,main postoperative complications and pathological diagnostic criteria,and cutting edge research progress on diagnostic criteria of rejection were illustrated,aiming to bring clinical benefits to more recipients undergoing heart transplantation.

关 键 词：心内膜心肌活组织检查(EMB) 急性细胞性排斥反应(ACR) T细胞介导的排斥反应(TCMR) 抗体介导的排斥反应(AMR) 移植心脏冠状动脉血管病(TCAD) 二代测序(NGS) 基因表达谱(GEP) 供者来源性细胞游离DNA(dd-cfDNA) 

分 类 号：R617[医药卫生—外科学] R36[医药卫生—临床医学]