Gouldesbrough D R, Axelsen R A
Department of Pathology, University of Edinburgh Medical School, UK.
Nephrol Dial Transplant. 1994;9(1):35-40.
Transplantation is the preferred method of renal replacement therapy in end-stage renal failure. Short- and medium-term graft survival is good but, in the longer term, grafts are lost due to vascular obliteration, i.e. chronic vascular rejection. The pathogenesis of these changes is unclear. We carried out a histopathological and immunocytochemical study of 31 vessels from 20 graft nephrectomies. Four patterns of arterial pathology were identified: (1) subendothelial inflammation ('endothelialitis') with little intimal thickening; (2) 'Endothelialitis' with thickening; (3) Intimal thickening without 'endothelialitis'; and (4) Intimal thickening with calcification and cholesterol clefts ('natural atherosclerosis'). We suggest that the lesions of chronic vascular rejection evolve, at varying rates, from an early 'endothelialitis' to a later stage with pronounced intimal thickening but no subendothelial inflammation. These changes probably reflect a delayed type hypersensitivity response involving activated macrophages and T lymphocytes and smooth muscle cell proliferation.
移植是终末期肾衰竭患者肾脏替代治疗的首选方法。短期和中期移植肾存活率良好，但从长期来看，移植肾会因血管闭塞（即慢性血管排斥反应）而丧失功能。这些变化的发病机制尚不清楚。我们对20例移植肾切除标本中的31条血管进行了组织病理学和免疫细胞化学研究。确定了四种动脉病变模式：（1）内膜下炎症（“内皮炎”），内膜增厚不明显；（2）伴有增厚的“内皮炎”；（3）无“内皮炎”的内膜增厚；（4）伴有钙化和胆固醇结晶的内膜增厚（“自然动脉粥样硬化”）。我们认为，慢性血管排斥反应的病变从早期的“内皮炎”开始，以不同的速率发展至后期，内膜明显增厚但无内膜下炎症。这些变化可能反映了一种迟发型超敏反应，涉及活化的巨噬细胞、T淋巴细胞和平滑肌细胞增殖。
