急性细胞性排斥伴补体裂解片断C4d沉积对移植肾预后的影响

目的探讨急性细胞性排斥伴肾小管周围毛细血管补体裂解片断(C4d)沉积对移植肾预后的影响。方法经病理证实的急性细胞性排斥肾移植患者145例,根据病理表现有否肾小管周围毛细血管C4d沉积,将其分为细胞性排斥+C4d阳性组(C4d阳性组)64例,单纯细胞性排斥组(C4d阴性组)81例。比较两组术前一般情况、排斥反应发病情况、抗排斥治疗、移植肾失功率及移植肾存活率。结果两组的术前一般情况比较差异无统计学意义(P0.05)。C4d阳性组的急性细胞性排斥反应发生时间明显早于C4d阴性组,比较差异有统计学意义(P0.05)。两组Banff分型Ⅰ型与Ⅱ型比例差异有统计学意义(P0.01)。随访期间C4d阳性组有22例(34%)移植肾失功,明显高于C4d阴性组的11例(14%),比较差异有统计学意义(P0.01)。Kaplan-Meier法分析发现C4d阳性组的移植肾存活率明显低于C4d阴性组(P0.01),移植肾的5年生存率分别为51%、79%。结论急性细胞性排斥反应伴肾小管周围毛细血管C4d沉积的肾移植患者,术后较早发生排斥反应,抗排斥治疗效果较差,移植肾存活率低。

Effect of acute cellular rejection with C4d deposition on renal allograft survival

Objective To explore the effect of acute cellular rejection with C4d deposition in peritu- bular capillary on renal allograft survival. Methods Acute cellular rejection was diagnosed in 145 patients according to Banff 97 criteria. According to the C4d deposition, Patients were divided into group A （ cellular rejection with C4d deposition, n =64） and group B （cellular rejection without CAd deposition, n = 81 ）. General condition before operation, reject reaction, antirejection therapy, graft loss rate and graft survival rate were compared between two groups. Results There was no significant difference in general condition （ P 〉 0. 05 ）. The patients in group A developed rejection earlier compared with group B （P 〈 0. 05 ）. The types of Banff was significantly different between two groups （ P 〈 0. 01 ）. The rate of renal allograft dysfuction was higher in group A than that in group B （34% vs 14% , P 〈0. 01 ）. Using Kaplan-Meier analysis, group A showed a lower survival rate of grafts compared with group B, with a 5-year graft survival rate of 51% and 79% respectively （P 〈 0. 01 ）. Conclusion Patients with cellular rejection with C4d deposition in peritubular capillary had earlier occurrence of rejection, poorer curative of antirejection therapy and lower graft survival rate.