心脏移植术后心内膜心肌活检的临床病理研究

目的 总结分析心脏移植术后心内膜心肌活检(EMB)的临床病理学特征。方法 对14例心脏移植手术患者的49次EMB进行光镜观察，并结合临床资料和相关文献进行分析。结果14例中6例出现急性排斥反应，其中3例仅有1级排斥反应，3例具有1～3级排斥反应。后3例中有2例无明显临床症状，仅外周血淋巴细胞绝对数有一定程度增高，供受体混合淋巴细胞培养检查结果阳性。结论 EMB是诊断心脏移植术后急性排斥反应的“金标准”；结合临床症状、外周血淋巴细胞绝对数检测和供受体混合淋巴细胞培养可减少EMB的检查次数。

Pathological and clinical features of endomyocardial biopsy of heart transplant

Objective To retrospectively review and analyze the histopathological features of endomyocardial biopsy (EMB) after heart transplants. Methods Fifty nine times of EMB in 14 cases were analyzed with light microscopy and the related literature was reviewed. Results Acute rejection occurred in 6 of 14 cases, 3 patients with grade 1 rejection and 3 cases with grades 1-3 rejection.Two of 3 patients with grade 3 acute rejection did not present distinct symptoms but utterly index of lymphocytes in blood was increased and the cultured mixed lymphocytes of donor and recipient were positive. Conclusion EMB is still the golden standard for judging acute rejection after heart transplant but EMB can be reduced by combining with clinical symptoms, utterly index of lymphocytes in blood and the cultured mixed lymphocytes of donor and recipient.