移植肺病理学诊断标准及其进展  

Diagnostic criteria and research progress on lung allograft pathology

作　　者：郭晖[1] Guo Hui(Institute of Organ Transplantation,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》2022年第1期19-31,共13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：近年来,随着肺移植外科技术和术后管理经验的积累,我国肺移植例数逐步增长。肺移植术后移植肺可出现多种并发症,主要包括由移植肺缺血-再灌注损伤(IRI)等所致的原发性移植肺无功能(PGD)、急性与慢性排斥反应以及移植术后应用免疫抑制剂所致机体免疫力下降出现的机会性感染或淋巴组织异常增生等。移植肺并发症的确诊主要依据移植肺活组织检查(活检)。本文对移植肺病理学研究的简史、移植肺活检的主要方法及其病理学处理技术、肺移植术后主要并发症及其活检病理学诊断标准进行阐述,旨在为指导临床对上述并发症采取针对性的治疗方案提供参考。In recent years,the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation.Multiple lung allograft complications may occur after lung transplantation,mainly including primary graft dysfunction(PGD)caused by ischemia-reperfusion injury(IRI)of the lung allograft,acute and chronic rejection,opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants,etc.The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft.In this article,the brief history of lung allograft pathology,main approaches and pathological processing techniques of lung allograft biopsy,major complications after lung transplantation and pathological diagnostic criteria were elucidated,aiming to provide reference for targeted management of these complications in clinical practice.

关 键 词：慢性阻塞性肺疾病 囊性纤维化 急性细胞性排斥反应(ACR) 抗体介导的排斥反应(AMR) T细胞介导的排斥反应(TCMR) 经支气管肺活检(TBLB) 经支气管冷冻肺活检(TBCB) 支气管肺泡灌洗 闭塞性细支气管炎(OB) 移植相关血管病(TAV) 

分 类 号：R617[医药卫生—外科学] R36[医药卫生—临床医学]