移植肾活检：病理及组织学的早期诊断价值

背景：移植肾活检病理学组织学早期诊断意义重大，单中心回顾性研究临床诊断与治疗较少。 目的：通过对肾功能不全移植肾进行常规穿刺病理活检，根据病理诊断采取相应临床治疗方式，观察治疗效果，同时明确移植肾穿刺病理活检的安全性以及在临床诊治中的意义及其重要性。 方法：选取解放军第309医院器官移植中心202例肾移植患者为研究对象，其中80例为肾移植后移植肾功能延迟恢复，122例肌酐不明原因升高。在B超引导下应用活检穿刺针行移植肾穿刺活检，对活检组织标本予以相应染色和病理组织学观察，并进行相应的临床治疗。 结果与结论：穿刺组织中，除3例(1.5%)由于组织少难以诊断，其余病理诊断移植肾正常12例(5.9%)，缺血再灌注损伤合并(或)急性肾小管坏死28例(13.9%)，轻度钙调磷酸酶抑制剂类免疫抑制剂急性毒性损伤22例(10.9%)，轻度钙调磷酸酶抑制剂类免疫抑制剂慢性毒性损伤12例(5.9%)，超急性排斥反应1例(0.5%)，疑为急性排斥反应29例(14.4%)，急性T细胞性排斥反应34例(16.8%)，急性抗体介导性排斥反应19例(9.4%)，慢性T细胞介导排斥反应16例(7.9%)，慢性T细胞介导排斥反应伴急性T细胞介导性排斥反应12例(5.9%)，慢性抗体介导性排斥反应3例(1.5%)，高血压因素4例(2.0%)，间质纤维化和肾小管萎缩，未发现特定致病因素所致病变2例(1.0%)，缺血性坏死2例(1.0%)，移植后肾病复发３例(1.5%)，C4d免疫组化染色阳性23例(11.4%)，未发现患者及移植肾的不良反应。

Kidney allograft biopsy: Pathological and histological values in early diagnosis

BACKGROUND:The kidney allograft biopsy has great pathological and histological significance in the early diagnosis. However, the retrospective study of clinical diagnosis and treatment is rare.  OBJECTIVE:To observe the effect of clinical treatments selected according to the pathological diagnosis which obtained through the wellness puncture biopsy on insufficiency renal allograft, and to identify the security and significance of grafted renal puncture biopsy in the clinical treatment. 　 METHODS:202 patients with renal transplantation were selected from the Organ Transplant Center, the 309th Hospital of Chinese PLA. Among them, 80 patients with delayed recovery of kidney function after kidney transplantation and 122 patients were found increasing creatinine content without explanation. With the guidance of B-ultrasound, a puncture needle was used to perform the kidney allograft biopsy, and the biopsy specimens were stained and histopathologically by observed for the corresponding clinical treatment. RESULTS AND CONCLUSION:All the patients were well accepted by biopsy, except three patients (1.5%) were difficult to be diagnosed because of less tissue. Twelve patients (5.9%) had normal graft kidney, 28 patients (13.9%) suffered from ischemia/reperfusion injury combined with acute tubular necrosis, 22 patients (10.9%) appeared with mild acute toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, 12 patients (5.9%) had mild chronic toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, one patient (0.5%) appeared with hyperacute rejection, 29 patients (14.4%) were doubted with acute rejection, 34 patients (16.8%) suffered with acute T-cell rejection, 10 patients (9.4%) appeared with acute antibody-mediated rejection, 16 patients (7.9%) appeared with chronic T cell-mediated rejection, 12 patients (5.9%) suffered from chronic T cell-mediated rejection combined with acute T cell-mediated rejection, three patients (1.5%) displayed chronic antibody-mediated rejection, four patients (2.0%) showed hypertension and related factors, two patients (1.0%) suffered from interstitial fibrosis and tubular atrophy without specific risk factors caused lesions, two patients (1.0%) presented with ischemic necrosis, three patients (1.5%) presented with nephropathy recurrence after transplantation and 23 patients were positive for C4d immunohistochemical staining. No adverse reaction was found in the patients or in the graft kidney.