穿刺活检和彩色多普勒诊断移植肾亚临床排斥反应的比较

目的　探讨穿刺活检和彩色多普勒对术后移植肾亚临床排斥反应的诊断价值。方法　选择术后 3个月无临床症状、肾功能正常的同种异体肾移植患者 96例 (男 5 4例 ,女 4 2例 ) ,平均年龄为 37 5岁 (17～ 5 8岁 ) ,先做移植肾彩色多普勒检查 ,然后在B超引导下行穿刺活检。结果　移植肾组织病理按Banff97分类法分型发现 ,30 2 % (2 9/96 )出现亚临床排斥反应。彩色多普勒以动脉血流阻力指数RI >0 76 ,动脉搏动指数PI>1 71为诊断的阳性标准 ,RI和PI诊断移植肾亚临床排斥的敏感性分别为 86 2 %、82 7% ,特异性分别为 88 1%、91 1%。结论　穿刺活检病理是诊断亚临床排斥反应的金标准 ,同时是简单、安全诊断方法 ;彩色多普勒对移植肾亚临床排斥反应的诊断具有较高的敏感性和特异性 ,且属无创、快速、经济的诊断方法。

Renal biopsy and Color Doppler Sonography in the diagnosis of subclical renal allograft rejection

Objective To evaluate biopsies and Color Doppler Sonography in the diagnosis of subclinical renal allograft rejection. Methods Ninety-six renal-allograft recipients with normal renal function and 3 months after transplantation were included in this study. There were 54 males and 42 females. Patients aged from 17 to 58 with a mean age of 37.5. Renal allograft was examed by color Doppler in each patient. Renal biopsy was performed under the gvildance of ultrasound. Results The histological diagnosis of allograft biopsy was made according to the Bannff Schema. In 30.3% of the biopsies, early subclinical rejection changes were found. For color Doppler Sonography, the diagnosis of subclinical rejection was made when RI>0.71 and PI>1.71. Increased RI and PI was significantly valuable in the diagnosis of subclinical rejection, with a sensitivity of 86.2% and 82.7% and a specificity of 88.1% and 91.1%. Conclusion Renal graft biopsy is a gold standard for the diagnosis of subclical rejection, It is a simple and safe technique. Color Doppler Sonography has high senstivity and specificity in diagnosis of subclinical rejection, providing a fast, accurate, non-invasive technique for the prediction of the renal subclinical rejection.