移植小肠病理学临床操作规范(2019版)

中华医学会器官移植学分会

doi:10.3969/j.issn.1674-7445.2019.05.015

移植小肠病理学临床操作规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.05.015

中华医学会器官移植学分会^,

200011 上海交通大学医学院附属第九人民医院(李幼生)；华中科技大学同济医学院附属同济医院器官移植教育部重点实验室卫健委器官移植重点实验室中国医学科学院器官移植重点实验室(郭晖)

基金项目:

国家卫生和计划生育委员会行业科研专项基金 201302009

中国医学科学院中央级公益性科研院所基本科研业务费专项基金 2018PT32018

华中科技大学自主创新基金项目 01-08-540149

详细信息

通讯作者:
郭晖，研究方向为移植病理学基础及临床应用研究，Email: zcguo@tjh.tjmu.edu.cn

中图分类号: R617, R36
计量
- 文章访问数: 213
- HTML全文浏览量: 66
- PDF下载量: 39
- 被引次数: 0
出版历程
- 收稿日期: 2019-06-27
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-09-15

Clinical operation specification for small intestine allograft pathology (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association^,

摘要

摘要: 为了进一步规范移植小肠病理学的临床操作，中华医学会器官移植学分会组织器官移植学专家和病理学专家从移植小肠活组织检查(活检)病理学诊断临床基本操作规范、移植小肠急性排斥反应活检病理学诊断及其分类、移植小肠急性排斥反应的基本病理学特征、移植小肠抗体介导的排斥反应、移植小肠慢性排斥反应、移植小肠的非排斥反应病变等方面，制订本规范。
- 器官移植 /
- 移植病理学 /
- 小肠移植 /
- 急性排斥反应 /
- 抗体介导的排斥反应(AMR) /
- 供体特异性抗体(DSA) /
- 缺血-再灌注损伤 /
- 感染

HTML全文

图 1 移植小肠急性排斥反应的经造口内窥镜检查图片

图示肠壁黏膜水肿，黏膜表面糜烂甚至可见直径0.3~0.6 cm的椭圆形或与黏膜皱襞平行的线型浅溃疡

Figure 1. Endoscopic examination images of acute rejection of the small intestine allograft

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图 2 移植小肠经抗排斥反应治疗后再次内窥镜检查图片

图示移植小肠充血水肿明显减轻，糜烂消失，溃疡明显愈合

Figure 2. Endoscopic reexamination images of small intestine allograft after anti-rejection therapy

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图 3 移植小肠可疑急性排斥反应的病理学特征

A图示移植小肠黏膜活检组织内黏膜上皮层完整，黏膜固有层内腺体排列规则，固有层仅轻度水肿、间质内仅少量炎性细胞浸润(HE，×100)；B图示隐窝上皮和固有层内腺体上皮偶见凋亡小体(HE，×200)

Figure 3. Pathological characteristics of suspicious of acute rejection in small intestine allograft

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图 4 移植小肠轻度急性排斥反应的病理学特征

A图示低倍镜下观察，小肠黏膜上皮完整，黏膜腺体排列规则，但固有层轻度水肿，有轻至中等量的单个核炎性细胞浸润(HE，×100)；B图示中倍镜下观察，黏膜固有腺体完整，数量多且排列规则，黏膜上皮层内偶有炎性细胞浸润，固有层内有单个核炎性细胞浸润(HE，×200)；C图示高倍镜下观察，隐窝上皮细胞凋亡数目增加(↑)(HE，×400)

Figure 4. Pathological characteristics of mild acute rejection in small intestine allograft

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图 5 移植小肠中度急性排斥反应的病理学特征

A图示小肠黏膜活检组织内的低倍镜观察，黏膜固有层内大量密集的单个核炎性细胞浸润，局部黏膜上皮变性、脱落呈糜烂(HE，×100)；B图示固有层内固有腺体明显减少，腺体排列紊乱，隐窝变浅及凋亡细胞数增加，间质大量炎性细胞浸润(HE，×400)

Figure 5. Pathological characteristics of moderate acute rejection in small intestine allograft

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图 6 移植小肠重度急性排斥反应的病理学特征

A图示移植小肠活检组织低倍镜观察，黏膜皱襞消失，上皮细胞坏死脱落，表面附炎性渗出物和坏死组织，固有腺体减少或消失，炎症累及黏膜下层(HE，×100)；B图示重度急性排斥反应的高倍镜观察，固有腺体上皮变性，凋亡细胞数明显增加，间质内大量炎性细胞浸润，并可见多数中性粒细胞(HE，×400)

Figure 6. Pathological characteristics of severe acute rejection in small intestine allograft

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图 7 移植小肠缺血-再灌注损伤的病理学特征(HE，×100)

图示小肠黏膜活检组织内小肠绒毛轻微水肿及少数黏膜上皮脱落

Figure 7. Pathological characteristics of ischemia-reperfusion injury in small intestine allograft

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图 8 移植小肠CMV感染后的小肠黏膜活检组织免疫组化染色图片(免疫组化，×400)

图示黏膜上皮细胞胞核及胞浆呈CMV病毒阳性

Figure 8. Immunohistochemical staining images of small intestinal mucosa biopsies after CMV infection in small intestine allograft

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