急性移植肾肾小球肾病及其病因学研究

对３３份移植肾及活检标本进行ＰＡＳ及六胺银染色，同时进行免疫组化分析，结果表明：肾移植术后急性移植肾肾小球肾病（ＡＡＧ）的发生率较高（５８％），其病理改变主要为肾小球毛细血管内皮细胞肿胀坏死；肾小球渗出性改变及基底膜增生性改变，有时可见免疫复合物沉积。对其病因的研究表明，ＡＡＧ发生与人巨细胞病毒（ＨＣＭＶ）感染及Ｔ细胞亚群改变有关。通过ＰＣＲ技术及ＥＬＩＳＡ法诊断ＨＣＭＶ感染，碱性磷酸酶抗碱性磷酸酶桥联酶标技术检测Ｔ细胞亚群，发现ＨＣＭＶ感染及ＣＤ４／ＣＤ８＜１．５组ＡＡＧ发生的相对危险度分别是未感染及＞１．５组的３２倍与１２倍。１０例接受移植肾活检的患者中，５例确诊为ＡＡＧ，其中３例因治疗无效而行移植肾切除术。ＡＡＧ是影响移植肾成活的重要问题，应予高度重视。

Acute allograft glomerulopathy and its etmlogy

cute allograft glomerulopathy (AAG) is a dis-tinctive glomerular lesion of renal allografts.Its clinicalsigns and symptoms. pathology and etiology werestudied. The frequency of AAG was 57. 6% in renaltransplant recipients. The clinical signs and syinptomsincluded urinary protein. cast , WBC and RBC, etc.The pathologic features were diffuse endothehal hyper-trophy and necrosis accompanied by accumulalion ofperiodic acid-schiff ( PAS) posrtive niaterial andmononuclear cells that resulted in obliteration ofglomerular capillaries, basilar membrane proliferationand immune complexes deposition. To elucidate thePathogenesis of AAG, we diagnosed HCMV infectionof renal transplantation recipients by using polyinerasechain reaction (PCR) and ELISA. Circulating T cellsubsets were detected with APAAP method. OR ofAAG occurrence in HCMV infection group was 32. 4times as high as in non-HCMV infection one (P<0.01 ). OR of AAG occurrence in CD4/CD8<1. 5 groupwas 12 times as high as in CD4/CD8>1. 5 one (P<0.o1 ); so AAG was strongly asaseiated with HCMV in-fection and T cell subsets changes (decreased or invert-ed CD4/CD8 ratio) induced by HCMV.