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移植肺病理学诊断标准及其进展

郭晖

郭晖. 移植肺病理学诊断标准及其进展[J]. 器官移植, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
引用本文: 郭晖. 移植肺病理学诊断标准及其进展[J]. 器官移植, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
Guo Hui. Diagnostic criteria and research progress on lung allograft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004
Citation: Guo Hui. Diagnostic criteria and research progress on lung allograft pathology[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 19-31. doi: 10.3969/j.issn.1674-7445.2022.01.004

移植肺病理学诊断标准及其进展

doi: 10.3969/j.issn.1674-7445.2022.01.004
基金项目: 

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资金资助 2019PT320014

详细信息
    通讯作者:

    郭晖,E-mail: zcguo@tjh.tjmu.edu.cn

  • 中图分类号: R617, R36

Diagnostic criteria and research progress on lung allograft pathology

More Information
  • 摘要: 近年来,随着肺移植外科技术和术后管理经验的积累,我国肺移植例数逐步增长。肺移植术后移植肺可出现多种并发症,主要包括由移植肺缺血-再灌注损伤(IRI)等所致的原发性移植肺无功能(PGD)、急性与慢性排斥反应以及移植术后应用免疫抑制剂所致机体免疫力下降出现的机会性感染或淋巴组织异常增生等。移植肺并发症的确诊主要依据移植肺活组织检查(活检)。本文对移植肺病理学研究的简史、移植肺活检的主要方法及其病理学处理技术、肺移植术后主要并发症及其活检病理学诊断标准进行阐述,旨在为指导临床对上述并发症采取针对性的治疗方案提供参考。

     

  • 图  1  移植肺IRI的病理学表现

    注:A图示肺泡腔内大量脱落的肺泡上皮细胞(箭头所示)(HE,×400);B图示移植肺肺泡表面透明膜形成(箭头所示)(HE,×200)。

    Figure  1.  Pathological findings of IRI in lung allograft

    图  2  移植肺A2级ACR的病理学表现

    注:图示小动脉分支内皮上炎症细胞浸润(箭头所示)及局部内膜水肿(星号所示)(HE,×400)。

    Figure  2.  Pathological findings of A2 grade ACR in lung allograft

    图  3  移植肺B1R级淋巴细胞性支气管炎的病理学表现

    注:图示细支气管黏膜上皮层内散在炎症细胞浸润(箭头所示)(HE,×1 000)。

    Figure  3.  Pathological findings of B1R grade lymphocytic bronchitis in lung allograft

    图  4  移植肺慢性排斥反应的OB的病理学表现

    注:图示细支气管管腔大部分为增生的纤维组织阻塞(星号所示)(HE,×400)。

    Figure  4.  Pathological findings of OB of chronic rejection in lung allograft

    图  5  移植肺慢性排斥反应的TAV的病理学表现

    注:图示移植肺内小动脉内膜显著增生增厚(箭头所示)致管腔明显狭窄(HE,×200)。

    Figure  5.  Pathological findings of TAV of chronic rejection in lung allograft

    图  6  移植肺毛霉菌感染的病理学表现

    注:图示移植肺活检组织内毛霉菌菌丝及孢子(Masson,×400)。

    Figure  6.  Pathological findings of mucor infection in lung allograft

    表  1  肺移植术后主要并发症

    Table  1.   Major complications after lung transplantation

    术后时间 并发症类型
    围手术期及术后近期
      (术后1个月内)
    血管与气管吻合口并发症、超急性排斥反应、植入反应、IRI或PGD、急性T细胞介导的排斥反应或AMR、感染
    术后中期
      (术后1个月至1年)
    急性T细胞介导的排斥反应或AMR、感染、移植后淋巴组织异常增生、药物毒性反应、通气相关病变
    术后远期
      (术后1年以上)
    急性细胞性排斥反应、急性AMR、感染、慢性支气管性排斥反应或闭塞性细支气管炎、慢性血管性排斥反应或移植相关血管病、限制性移植肺综合征、中性粒细胞性可逆性移植肺功能障碍、移植后淋巴组织异常增生、原发病复发
    下载: 导出CSV

    表  2  移植肺排斥反应诊断标准及其分级(2007年ISHLT标准)

    Table  2.   Diagnostic criteria and classification of rejection of lung allograft (2007 ISHLT working formulation)

    分级 诊断标准
    急性细胞性排斥反应(A级) A0级,无急性排斥反应;A1级,轻微急性排斥反应;A2级,轻度急性排斥反应;A3级,中度急性排斥反应;A4级,重度急性排斥反应
    淋巴细胞性支气管炎(B级) BX级,活检标本偏少或标本挤压等无法满足诊断;B0级,无淋巴细胞性支气管炎;B1R级,低级别的淋巴细胞性支气管炎;B2R级,高级别的淋巴细胞性支气管炎
    慢性支气管性排斥反应(OB)(C级) C0级,无OB改变;C1级,有OB改变
    慢性血管性排斥反应(TAV)(D级) D0级,无TAV病变;D1级,有TAV病变
    下载: 导出CSV
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  • 收稿日期:  2021-11-23
  • 网络出版日期:  2022-01-12
  • 刊出日期:  2022-01-15

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