慢性失功移植肾组织中C4d的表达与意义

目的 观察慢性失功移植肾组织中C4d的表达,探讨抗体介导的慢性活动性排斥反应与慢性移植肾失功的关系.方法 对本院27例经病理证实为慢性移植物损伤的移植肾组织行免疫组化或间接免疫荧光法检测肾小管周围毛细血管中C4d的沉积,分析C4d沉积与移植相关因素和移植肾预后的关系.结果 27例患者中,C4d阳性率为55.6％.C4d沉积阳性组病理改变以肾小球基底膜分层和动脉内膜增厚为主,C4d沉积阴性组以肾小管萎缩和间质纤维化为主；C4d沉积阳性组患者术前预致敏(PRA＞ 10％)和急性排斥反应发生率均高于C4d阴性组移植肾功能出现明显异常的时间早于C4d阴性组,差异均有统计学意义(P＜0.05).结论 抗体介导的慢性活动性排斥反应在移植物慢性失功中具有重要作用,其标志物C4d对诊断抗体介导的排斥反应和指导治疗具有重要的意义.

Expression and significance of complement split product C4d in chronic function loss renal allograft

Objective To observe the expression of C4d in renal allograft with chronic function loss and to investigate the relationship of chronic active antibody-mediated rejection and chronic allograft function loss.Methods Twenty-seven renal allografts of chronic graft injury that had been proved by pathology were analyzed by immunohistochemistry and indirect immunofluorescence was used to observe the deposition of complement split product C4d in peritubular capillaries.The relationship of C4d and transplant-related factors and prognosis of renal allograft were analyzed.Results All of the 27 patients,55.6% were C4d deposition positive.The patients with C4d positive sharply demonstrated glomerular basement membrane layered and endarterium incrassation,while C4d deposition negative group primary demonstrated that tubular atrophy,arteriolar intimal fibrosis and interstitial fibrosis.Incidence of presensitization(PRA>10%)and acute rejection were higher in patients with C4d positive,and onset of abnormal allograft function were also earlier in these patients than those of C4d deposition negative group(P<0.05).Conclusion Chronic active antibody-mediated rejection is involved in chronic renal function loss after the renal transplantation.Deposition of complement split product C4d in peritubular capillaries is very useful in diagnosis and treatment of antibody mediated rejection.