移植肾组织CAd沉积在慢性排斥反应中的意义

目的探讨体液免疫在移植肾慢性排斥反应中的作用及C4d在移植肾组织沉积的临床意义。方法对36例经病理确诊的慢性移植肾肾病(chronic allograft nephopathy,CAN)的移植肾穿刺标本做C4d免疫组化染色,观察C4d沉积情况,研究C4d沉积与慢性排斥病理形态表现及术后群体反应性抗体(pannel reactive antibody,PRA)的关系。结果36例CAN患者中,C4d阳性率为53%,C4d沉积与肾小球基底膜增生分层、动脉内膜纤维性增生和肾小管管周单核细胞浸润显著相关(P<0.05),C4d阳性与C4d阴性患者在肾小球硬化、肾小管萎缩及间质纤维化差异无显著性;C4d沉积与术后PRA显著相关(P<0.05)。结论抗体介导的体液免疫参与了移植肾慢性排斥反应的病理损伤过程;C4d是慢性体液排斥反应的特征性病理诊断指标。

C4d deposition in renal allograft biopsies and its significance in chronic rejection

Objective To investigate the role of humoral immunity in chronic rejection and the significance of C4d deposition in renal allograft.Methods C4d deposition in 36 renal allograft biopsies of patients with chronic allograft nephopathy (CAN) was by immunohistochemisty. The relationship between C4d deposition and pathology of chronic rejection and between C4d deposition and pannel reactive antibody (PRA) after transplantation were analyzed.Results In 36 cases of CAN, the positive rate of C4d deposition was 52%. C4d deposition was significantly correlated with chronic transplant glomerulopathy, arteriolar intimal fibrosis, and mononuclear cell in peritubular capillaries (P<0.05). There were no significant differences between C4d deposition positive and C4d deposition negative cases in glomerulosclerosis, tubular atrophy, and interstitial fibrosis. C4d deposition was significantly correlated with PRA after transplantation.Conclusion Humoral immunity mediated by antibodies is involved in chronic allograft rejection. C4d is a specific pathologic diagnosis criteria of chronic humoral rejection.