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肾移植术后局灶节段性肾小球硬化临床病理特征分析

张敏月, 兰平, 宫惠琳, 等. 肾移植术后局灶节段性肾小球硬化临床病理特征分析[J]. 器官移植, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
引用本文: 张敏月, 兰平, 宫惠琳, 等. 肾移植术后局灶节段性肾小球硬化临床病理特征分析[J]. 器官移植, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
Zhang Minyue, Lan Ping, Gong Huilin, et al. Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
Citation: Zhang Minyue, Lan Ping, Gong Huilin, et al. Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015

肾移植术后局灶节段性肾小球硬化临床病理特征分析

doi: 10.3969/j.issn.1674-7445.2023.01.015
基金项目: 

国家自然科学基金 82170768

详细信息
    作者简介:
    通讯作者:

    郑瑾,研究员,研究方向为肾移植,Email: jzheng@mail.xjtu.edu.cn

  • 中图分类号: R617

Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation

More Information
  • 摘要:   目的  探讨肾移植术后复发及新发局灶节段性肾小球硬化(FSGS)的临床和病理特征。  方法  选取经移植肾穿刺活组织检查(活检)病理确诊为FSGS的受者34例,根据自体肾原发病及循环渗透因子检测,将34例受者分为复发FSGS组(12例)和新发FSGS组(22例)。比较复发与新发两组间受者在临床指标及移植肾病理损伤程度的差异。  结果  两组受者系膜增生评分、肾小球球性硬化率、肾小管萎缩评分、间质纤维化评分和足细胞增生发生率之间的差异均无统计学意义(均为P > 0.05); 复发FSGS组受者的节段性肾小球硬化率为0.10(0.08,0.27),低于新发FSGS组受者的0.19(0.13,0.33)(P < 0.05)。两组受者抗体介导的排斥反应、药物性肾小管损伤、BK病毒感染发生率之间的差异均无统计学意义(均为P > 0.05); 复发FSGS组受者T细胞介导的排斥反应发生率为17%,低于新发FSGS组受者的55%(P < 0.05)。免疫组织化学结果显示移植肾组织内浸润炎症细胞主要为T细胞; 复发FSGS组和新发FSGS组管周毛细血管C4d沉积阳性率分别为33%(4/12)和32%(7/22),差异无统计学意义(P > 0.05); 免疫荧光结果显示多数病例移植肾肾小球节段性硬化区IgM团块状沉积,电子显微镜显示移植肾肾小球均存在足突广泛融合或节段性分布。  结论  复发FSGS组肾损伤程度和T细胞介导的排斥反应发生率低于新发FSGS组。综合分析肾移植受者术前和术后的临床表现、实验室检测和病理学检查等有助于复发和新发FSGS的早期诊断和治疗。

     

  • 图  1  移植肾免疫组织化学、免疫荧光和电镜图片

    注:A图为复发FSGS,图示肾小球节段性硬化(苏木素-伊红,×200); B图为新发FSGS,图示肾小球节段性硬化(过碘酸-雪夫,×200); C图为复发FSGS,图示足细胞增生(过碘酸-六胺银,×400); D图为急性TCMR,图示肾小管炎(过碘酸-雪夫,×200); E图为慢性活动性AMR,图示肾小球毛细血管基底膜增厚、双轨形成(过碘酸-雪夫,×200); F图为新发FSGS伴药物性肾损伤(苏木素-伊红,×200); G图为新发FSGS受者BKV感染的肾小管上皮细胞核SV40(+)(免疫组化,×100); H图为肾小球节段性硬化区IgM团块状沉积(免疫荧光,×200); I图为电镜示足突广泛融合或节段性分布(磷钨酸,×4 300)。

    Figure  1.  Immunohistochemistry, immunofluorescence and electron microscopy images of renal allograft

    表  1  两组受者病理学参数的比较

    Table  1.   Comparison of pathological parameters of recipients between the two groups

    病理学参数 复发FSGS组(n=12) 新发FSGS组(n=22) 统计值 P
    系膜增生评分[M(P25, P75),分] 1.25(1.00,1.25) 1.00(1.00,1.00) -1.888 0.136
    肾小球球性硬化率[M(P25, P75)] 0.07(0,0.33) 0.20(0.07,0.38) -1.305 0.204
    节段性肾小球硬化率[M(P25, P75)] 0.10(0.08,0.27) 0.19(0.13,0.33) -2.244 0.025
    肾小管萎缩评分[M(P25, P75),分] 1.0(1.0,1.0) 1.0(1.0,1.0) -0.974 0.488
    间质纤维化评分[M(P25, P75),分] 1.0(0,1.0) 1.0(1.0,1.0) -0.735 0.534
    足细胞增生发生率[n(%)] 4(33) 7(32) 0.031 0.583
    下载: 导出CSV

    表  2  两组受者并发症发生率比较

    Table  2.   Comparison of complication rates of recipients between the two groups[n(%)]

    并发症 复发FSGS组(n=12) 新发FSGS组(n=22) 统计值 P
    AMR 0 4(18) 2.473 0.158
    TCMR 2(17) 12(55) 4.600 0.035
    药物性肾小管损伤 0 5(23) 3.197 0.095
    BKV感染 0 1(5) 0.562 0.647
    下载: 导出CSV
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  • 收稿日期:  2022-09-22
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

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