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摘要: 为了进一步规范器官移植病理学临床技术操作,中华医学会器官移植学分会组织器官移植专家和移植病理学专家,从移植病理学诊断的基本内容、基本原则、基本方法等方面,制定器官移植病理学临床技术操作规范(2019版)之移植病理学诊断的基本规范;从尸体供肾病理学评估、移植肾活组织检查(活检)病理学临床技术操作规范、移植肾活检病理学诊断临床技术操作规范、移植肾活检电镜诊断临床技术操作规范等方面,制定器官移植病理学临床技术操作规范(2019版)之移植肾脏病理学临床技术操作规范。
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图 3 移植肾穿刺活检组织标本分切方式
LM为光镜标本,IF为免疫荧光显微镜标本,EM为电镜标本;A图示自皮质端取2 mm作电镜标本,4 mm作免疫病理标本,其余部分用作光镜标本;B图示自皮质端依次割为1、2、4 mm的数段,然后依次隔段分作三堆以分别进行电镜、免疫病理及光镜检查,这种分割法可以保证各种检查的标本中均可能包含肾小球;C图示若取得的标本细而且短,则应及时考虑重穿,各条标本分作光镜、免疫病理及电镜的检查,或可将第2针的活检组织分为荧光和电镜标本
Figure 3. The method of dividing the biopsy tissue of transplanted kidney
图 11 移植肾复发性草酸盐肾病和Fabry病的病理学特征
A、B图为移植肾复发性草酸盐肾病的病理学表现,A图示肾移植术后2个月的移植肾穿刺活检组织多数肾小管腔内均可见透明样、碎玻璃草酸盐结晶堵塞(HE,×400),B图示在偏振光显微镜下,草酸盐结晶呈明显的折光(×200);C图为移植肾复发性Fabry病的病理学表现,图示移植肾活检组织电镜检查中可见大部分足细胞内有特征性的“髓样小体或斑马小体”沉积(×6 000)
Figure 11. Pathological characteristics of recurrent oxalate nephropathy and Fabry disease of renal allograft
图 12 电镜下常见的移植肾病理学特征
A图为肾移植术后移植肾复发性IgA肾病,图示肾小球系膜区高密度块状电子致密物沉积(★,×5 000);B图为肾移植术后移植肾复发性FSGS,图示肾小球足细胞足突广泛融合(↑,×8 000);C图为移植肾急性TMA,图示肾小球毛细血管内皮细胞肿胀,内皮下间隙增宽(★,×8 000),间隙内填充有低电子密度的无定形物质;D图为移植肾肾小球炎,图示肾小球毛细血管腔内可见多个淋巴细胞(↑,×5 000);E、F图为移植肾慢性活动性AMR所致移植肾肾小球病和肾小管管周毛细血管基膜多层化,E图示肾小球毛细血管袢增厚、基底膜双层化(↑,×5 000);F图示肾小管周毛细血管基膜增厚及增生为多层(↑,×6 000)
Figure 12. Common pathological characteristics of renal allograft under electron microscopy
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