Peritubular capillaries in chronic renal allograft rejection: a quantitative ultrastructural study.
Peritubular capillaries in chronic renal allograft rejection: a quantitative ultrastructural study.
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慢性肾同种异体移植排斥中的管周毛细血管：定量超微结构研究。
DOI：
10.1053/hupa.2000.16677
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发表时间：
2000
期刊：
影响因子：
3.3
通讯作者：
K. Solez
中科院分区：
文献类型：
--
作者：
B. Iványi;H. Fahmy;H. Fahmy;H. Fahmy;H. Brown;H. Brown;H. Brown;P. Szenohradszky;P. Halloran;P. Halloran;P. Halloran;K. Solez;K. Solez;K. Solez
具有周向多层基底膜的肾小管周围毛细血管(PC)被认为是移植肾慢性排斥反应(CR)的超微结构指标。作者通过对169例肾活检标本的定量特征、特异性和敏感性的分析，证实了这一病变是CR的标志。观察CR46例、急性排斥反应11例、正常肾脏20例、环孢素A治疗银屑病13例、慢性环孢素A中毒肾移植12例、先天性肾脏疾病56例、CR所致移植肾切除11例的肾活检标本的平均环状层数和分级(轻度2~4层，中度5~6层，重度7层以上)。根据临床特征和存在内膜纤维化的41例活检标本或35例移植肾小球病变的活检标本(CG；10例仅经电子显微镜证实)诊断为CR。NKD包括慢性肾小球肾炎、慢性间质性肾炎、良性肾硬化、血栓性微血管病变、糖尿病肾病和老年患者的肾脏疾病(中位年龄，72岁)。对肾小球周围的所有PC进行采样(中位数，每例14例)。中/重度病变的PC在半薄的塑料切片上表现为锯齿状轮廓，基底膜厚厚，呈带状。环状多层PC的数量是CR的显著特征(CR的PCCirc(Bx)：2.87+/-1.83SD；范围0~7.36；P<；.001v其他组)。严重病变仅发生在CR中(CR(Bx)中12%的PC，CRner中38%)。中度病变在NKD中占0.6%，在CR(Bx)中占16%，在CRnear中占21%。仅在CR组出现三个或三个以上中度损害的PC。轻度病变完全不提示CR。在CR(Bx)中，27例显示重度病变或3例以上PC合并中度病变(CPC；敏感性：59%)。27例中有4例缺乏CG。CPC和CG的累积发生率为85%。在环孢素毒性的移植中，CPC的存在证实了7个标本中存在CR。结论：CPC是CR的特异性标志物。随着CR的进展，CPC的发生率增加。这种损害可能是由PC的低级别排斥损伤引起的。对半薄切片的仔细分析有助于更好地采样CPC。CPC和CG的超微结构显示比光学显微镜评估本身更准确地定义CR。
Peritubular capillaries (PCs) with a circumferentially multilayered basement membrane have been suggested as an ultrastructural indicator of chronic renal allograft rejection (CR). The authors validated this lesion as a marker for CR, by analyzing its quantitative features, specificity, and sensitivity in 169 renal biopsy specimens. The mean number of circumferential layers (PCcirc) and the incidences of the grades (mild: 2 to 4, moderate: 5 to 6, severe: 7 or more layers) were investigated in biopsy specimens involving CR (CR(Bx), n = 46), acute rejection (n = 11), normal kidneys (n = 20), psoriatics treated with cyclosporine (n = 13), renal transplants with chronic cyclosporine toxicity (n = 12), native kidney diseases (NKD, n = 56), and transplant nephrectomies attributable to CR (Cr(nephr), n = 11). CR was diagnosed with regard to the clinical features and the presence of intimal fibrosis in 41 biopsy specimens or transplant glomerulopathy in 35 biopsy specimens (cg; identified only by electron microscopy in 10 cases). NKD included chronic glomerulonephritis, chronic tubulointerstitial nephritis, benign nephrosclerosis, thrombotic microangiopathy, diabetic nephropathy, and renal disease in elderly patients (median age, 72 years). All PCs around glomeruli were sampled (median, 14 profiles per case). PCs with a moderate/ severe lesion appeared as serrated profiles with a thick, ribbon-like basement membrane layer in semithin plastic sections. The numbers of circumferentially multilayered PCs were significantly characteristic of CR (PCcirc in CR(Bx): 2.87+/-1.83 SD; range, 0 to 7.36; P < .001 v other groups). A severe lesion occurred exclusively in CR (in 12% of the PCs in CR(Bx), and in 38% in CRnephr). A moderate lesion was observed in 0.6% of the PCs in NKD, 16% in CR(Bx), and 21% in CRnephr. Three or more PCs with a moderate lesion were encountered only in CR. A mild lesion was not suggestive of CR at all. In CR(Bx), 27 cases showed a severe lesion or 3 or more PCs with a moderate lesion (cpc; sensitivity: 59%). Four of the 27 cases lacked cg. The cumulative incidence of cpc and cg was 85%. In transplants with cyclosporine toxicity, the presence of cpc verified the coexistence of CR in 7 specimens. In conclusion, cpc is a specific marker of CR. The incidence of cpc increases as CR progresses. The lesion may be caused by a low-grade rejection injury to the PCs. Careful analysis of semithin sections promotes the better sampling of cpc. An ultrastructural demonstration of cpc and cg defines CR more precisely than does light microscopic evaluation per se.