Eur Radiol:肾移植后,如何发现移植肾亚临床病理改变?

2021-02-23 shaosai MedSci原创

血清肌酐测量是一种非常有用和广泛使用的临床工具,快速和无创评估肾移植。然而,肌酐由于敏感性较低,尤其在亚临床病理情况下,肌酐价值有限。

      肾移植是一种成熟的治疗终末期肾病患者的方法,移植后密切监测移植器官的功能是延长同种异体肾移植寿命的关键。血清肌酐测量是一种非常有用和广泛使用的临床工具,快速和无创评估肾移植。然而,肌酐由于敏感性较低,尤其在亚临床病理情况下,肌酐价值有限。现有研究表明这些亚临床病理的存在影响肾移植远期预后。然而,最常见的没有明显临床症状(亚临床排斥)的排斥病例,仅可通过移植物活检确诊,此种方法虽为病理诊断的金标准,但此种方法为侵入性检查,且并发症较多,临床上很难重复进行。

       功能性磁共振成像(MRI)具有无创性和良好的可重复性,已广泛运用于各个器官及组织。最近有报道表明,动脉自旋标记(ASL)序列可以实现对慢性肾病的分类,并显示急性肾损伤的病理变化。


      近日,发表在European Radiology杂志的一项研究表明使用ASL作为一种非侵入性生物标记物用于肾移植功能稳定患者亚临床病理的早期检测。

    本研究前瞻性的纳入了75例患者,包括18例组织学正常的稳定移植物(正常组),21例经活检证实的亚临床病理的移植物(亚临床病变组)和36例功能不稳定的移植物(不稳定移植组),每例患者均行ASL磁共振成像。使用受试者器工作特性曲线计算曲线下的面积(AUC)、灵敏度和特异性。

    3组患者的人口统计学信息具有可比性。亚临床病理组和不稳定移植组的肾脏同种异体皮质ASL值明显低于正常组204.7±44.9 ml / min / 100 g vs 152.5±38.9 ml / min / 100 g vs 92.3±37.4 ml / min / 100 g,p <0.001)。皮层ASL区分亚临床病理移植物与正常移植物的AUC、敏感性和特异性分别为0.92(95%CI,0.83-0.97)、71.9%和100%, 血清肌酐区分亚临床病理移植物与正常移植物的AUC、敏感性和特异性分别为分别为0.82(95%CI,0.72-0.90)、54.4%和100%。 皮质ASL在功能稳定的患者中鉴定出亚临床病理的AUC为0.80(95%CI,0.64-0.91)、敏感性为57.1%,特异性为88.9%。结合蛋白尿和皮质ASL可以将鉴别亚临床病理组与正常组的敏感性和特异性分别提高到76.2%和100%。

典型的组织学发现和ASL结果的例子。组织学正常的同种异体移植物(a, PAS染色×200),移植物灌注保存良好(b)。而亚临床排斥反应患者(c, PAS染色×200),移植物灌注(d)较正常减少。肌酐显著升高,活检显示广泛纤维化和炎症(e, PAS染色×200),肾移植灌注(f)进一步降低

用于区分正常同种异体病变与正常同种异体移植物的受体工作特性曲线(a)和具有正常同种异体亚临床病理的稳定同种异体移植物(b)

 

    皮层ASL可用于识别具有潜在病理改变的同种异体移植物。更重要的是,ASL有望作为一种非侵入性工具用于临床移植术时鉴定具有亚临床病变的肾脏同种异体移植物。


原始出处:

 Wei Wang,Yuanmeng Yu,Xue Li,et al. Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling.DOI:10.1007/s00330-020-07369-5

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    2021-02-24 ms5000000518166734

    已读,受益匪浅

    0

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    2021-02-24 Ernest Chan

    👍

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1797484, encodeId=1b591e974840a, content=<a href='/topic/show?id=96eb22906b9' target=_blank style='color:#2F92EE;'>#临床病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22906, encryptionId=96eb22906b9, topicName=临床病理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Mar 08 18:12:32 CST 2021, time=2021-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016786, encodeId=fe4b1016e8694, content=<a href='/topic/show?id=6a3e24204fc' target=_blank style='color:#2F92EE;'>#亚临床#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=24204, encryptionId=6a3e24204fc, topicName=亚临床)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Sun Sep 12 15:27:47 CST 2021, time=2021-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808954, encodeId=d4e01808954b8, content=<a href='/topic/show?id=8dcb826216c' target=_blank style='color:#2F92EE;'>#肾移植后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82621, encryptionId=8dcb826216c, topicName=肾移植后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Thu Jan 27 18:12:32 CST 2022, time=2022-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926916, encodeId=7c129269169d, content=已读,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Wed Feb 24 18:23:30 CST 2021, time=2021-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926793, encodeId=80d1926e9301, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKAt57ta3VUu0KqJbesSDnySTM9t66FcZibb9aPt4icjKlh4UraKEOic11C1Uz2vQf99pubJpn9fRaLg/132, createdBy=a77b2365756, createdName=Ernest Chan, createdTime=Wed Feb 24 09:47:22 CST 2021, time=2021-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1050257, encodeId=b3d3105025e43, content=大家一般关心疾病,但是亚临床更重要,这是疾病防控方向的前移,各类疾病都是这样。如亚临床甲减,亚临床心肌损伤,亚临床心衰等, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=jingjing, createdTime=Wed Feb 24 00:12:32 CST 2021, time=2021-02-24, status=1, ipAttribution=)]
    2021-02-24 jingjing

    大家一般关心疾病,但是亚临床更重要,这是疾病防控方向的前移,各类疾病都是这样。如亚临床甲减,亚临床心肌损伤,亚临床心衰等

    0

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