移植肾临界改变干预的长期观察

目的 察移植肾活检病理呈临界改变的肾功能异常患者的预后，探讨合适的治疗方案。方法 在肾移植术后1年内，移植肾病理诊断为临界改变的50例患者进行长期随访。根据其肾穿刺时血清肌奸水平分为肾功能异常组（n=29，A组）和肾功能正常组（n=21，B组），并以移植肾病理无特殊改变者作为正常对照（n=13，C组）。比较临床预后厦病理组织中的病理学特征、免疫荧光和免疫组化改变。结果 组术后3月肌酐为（131．164-21．37）mol／L，明显高于B组和c组（P分别〈0．001和O．03），但3组在术后6月和1年的肌酐水平相近。A组慢性肾功能不全发生率较其他两组高，但差异无统计学意义（均P〉0．05）。间质浸润和间质纤维增生在A组多见（均P〈0．05），在B组中IgM的沉积较多见（P（0．05）。在A和旧组中均未发现C4e和clq的免疫荧光染色，IgG，IgA的免疫荧光染色和补体C3d、c4d在小管旁毛细血管的沉积在两组中差异无统计学意义（均P〉0．05），c4d阳性组慢性肾功能不全发生率明显较C4d阴性组高rP〈0．05）。结论 植肾界改变患者存在长期预后较正常改变者差的趋势，对临床上肾功能异及病理中C4d阳性的临界改变患者应加强免疫治疗。

Long term follow up of renal transplant recipients with borderline change

Objective To investigate prognosis of renal transplant recipients with pathological borderline change and to find out an optimal therapy. Methods 50 renal transplant recipients with borderline change within 1 year post transplantation were enrolled, and were divided into A group and B group according to the creatinin level. In addition, 13 recipients (group C) with normal change in biopsies were served as controls. The clinical outcome and pathological features were compared between 3 groups. Results The creatinin level in 3 month post transplantation was highest in A group with statistical significance,the creatinin levels in 6 month and 1 year were not different among groups( P>0.05), The free of graft dysfunction rate was lowest in group A , and reached marginal statistical significance compared to group C( P>0.05). Group A showed significant more interstitial infiltration and interstitial fibrosis, but the differences in other pathological feature, Immunofluorescence stain of IgG, IgA, C3c and the C4d, C3d staining in Peritubular capillaries (PTCs) were not significant between A and B groups. The free of graft dysfunction rate was much lower in C4d positive group than the negative group( P<0.05).Conclusion Borderline change is associated with the tendency of impaired graft function. The borderline change with elevated creatinin or deposition of complement factor C4d in PTCs is characterized by a worse clinical outcome and additional treatment is recommended.