肾移植术后超声引导下移植肾穿刺病理结果特点分析  

Analysis of pathological results of ultrasound-guided renal puncture after kidney transplantation

作　　者：吕熙楠 杜春恺 吕竟成 王志鹏[1] 张健[1] 郑蒙蒙 赵美姗 易展雄 朱一辰[1] Lyu Xi′nan;Du Chunkai;Lyu Jingcheng;Wang Zhipeng;Zhang Jian;Zheng Mengmeng;Zhao Meishan;Yi Zhanxiong;Zhu Yichen(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050 [2]首都医科大学附属北京友谊医院超声科,北京100050

出　　处：《国际外科学杂志》2024年第6期403-408,I0013,共7页International Journal of Surgery

摘　　要：目的分析肾移植术后超声引导下移植肾穿刺的病理结果及不同类型疾病的发病特点。方法采用回顾性研究方法,选取2020年6月—2022年4月于首都医科大学附属北京友谊医院因检验异常或出现不适症状行超声引导下移植肾穿刺病理活检的257例患者,分析移植肾穿刺活检术后患者的穿刺病理结果、不同类型疾病的发病特点及穿刺相关并发症发生情况。符合正态分布的计量资料以均数±标准差(x±s)表示,不同类型疾病之间比较采用独立样本t检验;不符合正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,不同类型疾病之间比较采用非参数检验;计数资料不同类型疾病之间比较采用χ^(2)检验。结果257例接受移植肾穿刺的患者中,93例(36.2%)患有抗体介导的排斥反应(ABMR),76例(29.6%)患有IgA肾病,63例(24.5%)患有细胞介导的排斥反应(TCMR),21例(8.2%)患有多瘤病毒相关性肾病(PVAN),4例(1.6%)患有血栓性微血管病(TMA),16例(6.2%)患有糖尿病肾病,12例(4.7%)患有钙调神经磷酸酶抑制剂(CNI)肾病。TCMR、TMA、PVAN显著发生于肾移植术后早期(4年内)(P<0.001),ABMR显著发生于肾移植术后晚期(约8年后)(P<0.001)。在时间分布方面,肌酐异常与蛋白尿是穿刺的主要原因。在诊断患有PVAN的人群中,因肌酐异常进行穿刺的人群的移植时间明显短于因蛋白尿进行穿刺的人群(P=0.011)。在穿刺相关并发症方面,共8例复查时发现动静脉瘘,2例出现肾周血肿,1例同时出现以上2种穿刺相关的并发症。结论肾移植患者移植肾并发症主要包括ABMR、IgA肾病、TCMR、PVAN、糖尿病肾病、CNI肾病及TMA。在移植后不同类型疾病发病特点方面,移植后PVAN、TMA、TCMR多发生在肾移植术后早期,而ABMR发生时间较晚。但值得注意的是,不同类型移植肾相关疾病的临床症状相似且并不典型。Objective To analyze the pathological findings of ultrasound-guided transplant kidney puncture after renal transplantation and the pathogenesis of different types of diseases.Methods A retrospective study was conducted to select 257 patients who underwent ultrasound-guided transplant kidney puncture pathology biopsy due to abnormal tests or uncomfortable symptoms at Beijing Friendship Hospital,Capital Medical University from June 2020 to April 2022,and to analyze the pathological results of puncture and the pathogenesis of different types of diseases and puncture-related complications in the post-transplantation patients after transplant kidney puncture biopsy.Measurement data conforming to normal distribution were expressed as mean±standard deviation(x±s),and independent sample t-test was used to compare different types of diseases;measurement data did not conform to normal distribution were expressed as median(interquartile distance)[M(Q_(1),Q_(3))],and the comparison between different types of diseases was conducted by non-parametric test.The count data were compared among different types of diseases using Chi-squre test.Results Among the 257 patients who underwent transplant renal puncture,93 cases(36.2%)suffered from antibody-mediated rejection(ABMR),76 cases(29.6%)suffered from IgA nephropathy,63 cases(24.5%)suffered from T cell-mediated rejection(TCMR),21 cases(8.2%)suffered from polyomavirus-associated nephropathy(PVAN),and 4 cases(1.6%)suffered from thrombotic microangiopathy(TMA),16 cases(6.2%)suffered from diabetic nephropathy,and 12 cases(4.7%)suffered from calcineurin inhibitor(CNI)nephropathy.TCMR,TMA and PVAN occurred significantly in the early post-transplantation period(within about 4 years)(P<0.001),and ABMR occurred significantly in the late post-transplantation period(after about 8 years)(P<0.001).In terms of time distribution,creatinine abnormality and proteinuria were the main reasons for puncture.Among those diagnosed with PVAN,the time to transplantation was significantly shorter in thos

关 键 词：肾移植 病理学 临床 穿刺术 

分 类 号：R699.2[医药卫生—泌尿科学]