基于肾小管形态学变化的供肾损伤程度对早期移植效果的影响  

Effects of donor kidney injury degree based on morphological changes of renal tubules on early kidney transplantation efficacy

作　　者：刘磊[1] 朱昆仑 邱阳 李新强 罗振宇 庞新路[1] 王军祥[1] 丰贵文[1] LIU Lei;ZHU Kunlun;QIU Yang;LI Xinqiang;LUO Zhenyu;PANG Xinlu;WANG Junxiang;FENG Guiwen(Department of Kidney Transplantation,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Department of Pathology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院肾移植科,郑州450052 [2]郑州大学第一附属医院病理科,郑州450052

出　　处：《郑州大学学报（医学版）》2024年第5期697-701,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省高等学校重点科研项目计划(23A320002)。

摘　　要：目的:探讨基于肾小管形态学变化的供肾损伤程度分级方法,及基于该分级的损伤程度对移植效果的影响。方法:回顾性收集郑州大学第一附属医院2019年5月1日至2022年9月30日实施肾移植的70例ATI供者和139例受者资料。将肾小管上皮细胞存在形态学改变及基底膜裸露范围<10%的供肾受者定义为轻度损伤组(n=60),将肾小管上皮细胞存在形态学改变及裸露范围10%~50%的供肾受者定义为中度损伤组(n=79);肾小管上皮细胞存在梗死或凝固性坏死且肾小管基底膜裸露范围>50%为重度损伤,不用作供肾。比较两组术后第7天,1、3、6、12、18、24个月时的肾功能(eGFR)以及肾功能延迟恢复(DGF)发生率。结果:两组eGFR随时间延长而增高(P<0.05),但组间eGFR差异无统计学意义(P=0.058)。中度损伤组DGF发生率为51.9%,DGF持续时间的中位数(四分位数)为30.0(20.5,43.0)d,高于轻度损伤组[21.7%,18.0(16.5,21.5)](P<0.05)。结论:供肾移植前基于肾小管形态学变化进行损伤程度分级评估能够预测受者移植效果;轻、中度供肾损伤均可用于供肾移植,但中度损伤的供肾有更大DGF和肾功能损害的风险。Aim:To explore the classification of donor kidney injury based on morphological changes of renal tubules,and the effects of different injury degree of donor kidneys on kidney transplantation efficacy.Methods:Seventy cases of acute tubular injury donors and 139 recipients were collected from the First Affiliated Hospital of Zhengzhou University from May 1,2019 to September 30,2022.The renal tubule epithelial cells with morphological changes and the bare range of the basement membrane<10%,10%-50%and>50%of the donor kidneys was defined as mild injury,medium injury,and severe injury.The recipients were allocated into mild injury group(n=60)and medium injury group(n=79)accordingly.The incidence of delayed graft function(DGF)as well as glomerular filtration rate(eGFR)within 2 years after operation of the 2 groups were compared.Results:eGFR in both groups was increased with time and there was no significant difference between the 2 groups(P=0.058).The incidence of DGF of mild injury group was 51.9%,and the duration of DGF was 30.0(20.5,43.0)days,higher than those[21.7%,18.0(16.5,21.5)days]of medium injury group(P<0.05).Conclusion:The classification of donor kidney injury based on morphological changes of renal tubules could predict the efficacy of kidney transplantation;donor kidneys with mild and medium injury both could be used in kidney transplantation,and donor kidneys with medium injury may have greater risk of DGF and renal impairment.

关 键 词：肾移植 移植前活检 急性肾小管损伤 肾功能延迟恢复 

分 类 号：R692.5[医药卫生—泌尿科学]