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目的：进一步探讨急性排异的临床病理学特点和发生机理，为临床诊断及治疗提供参考。方法：分析１４４例急性排异的临床病理资料，观察内皮素（ＥＴ）在移植肾组织中的分布和相对含量。结果：１．急性排异反应的病理变化为：①间质水肿、充血、出血，淋巴细胞、单核细胞浸润；②动脉内膜炎、全层炎及血管壁纤维样坏死；③肾小管上皮浊肿、变性、坏死。２．急性间质型排异反应移植肾内ＥＴ的分布以血管内皮细胞损害为主，ＥＴ的相对含量均较血管型组升高，而其它部位无明显升高。急性血管型排异反应移植肾内ＥＴ的分布以肾小球入球动脉为主，呈节段性和局灶性，测定其含量均呈上升趋势，在ＥＴ表达较强的病例中，肾小球毛细血管丛缩小，管腔不易分辨，系膜细胞增生，系膜区扩大。结论：①急性排异反应病变的程度和肾移植的时间并不成正相关，作者根据病变程度和临床工作的需要，将其病理学改变分为轻、中、重三级。在此基础上提出了相应的临床治疗方案。②从形态上证实了ＥＴ升高对移植肾功能损害的状况，说明ＥＴ的产生与升高是排异发生的原因之一。推测应用ＥＴ受体拮抗剂对延缓急性排异反应损伤可能有一定的意义。
Objective: To further explore the clinicopathological characteristics and pathogenesis of acute rejection, and provide reference for clinical diagnosis and treatment. Methods: The clinicopathological data of 144 cases of acute rejection were analyzed to observe the distribution and relative content of endothelin (ET) in renal allograft. Results: 1. Pathological changes of acute rejection: interstitial edema, congestion, bleeding, lymphocytes, monocyte infiltration; ② endocarditis, full-thickness inflammation and fibrovascular necrosis; ③ tubule epithelial turbidity, degeneration , Necrosis. 2. The distribution of ET in acute interstitial rejection graft was mainly vascular endothelial cell damage, the relative content of ET was higher than that in vascular group, but not in other parts. The distribution of intrarenal ET in acute vascular rejection was mainly in glomerular afferent artery, which was segmental and focal. The content of ET was increased in all cases. In the cases with strong ET expression, Ball capillaries narrow, difficult to distinguish the lumen, mesangial cell proliferation, mesangial area expanded. Conclusions: ① The degree of acute rejection reaction does not correlate with the time of kidney transplantation. The author divided the pathological changes into mild, moderate and severe grade according to the degree of the disease and the need of clinical work. On this basis, put forward the corresponding clinical treatment plan. ② morphologically confirmed the role of ET increased renal damage, indicating that the emergence and rise of ET is one of the causes of rejection. Speculated that the application of ET receptor antagonists may delay the acute rejection reaction may have some significance.