移植肾组织中C4d沉积、浆细胞聚集性浸润及其与体液性排斥反应的关系  

A retrospective study on the deposition of peritubular capillary C4d and infiltration of plasmocytes nodules in renal allograft and their correlations with humoral rejection

作　　者：许晓光[1] 石炳毅[1] 蔡明[1] 王强[1] 韩永[1] 周文强[1] 许亮[1] 肖漓[1] 

机构地区：[1]解放军总医院第二附属医院器官移植中心,北京100091

出　　处：《中华器官移植杂志》2008年第5期290-293,共4页Chinese Journal of Organ Transplantation

基　　金：基金项目：全军“十一五”计划科技攻关课题（06G115）

摘　　要：目的检测因排斥反应而丧失功能的移植。肾组织中浆细胞的浸润情况及补体（34裂解产物CAd的沉积情况，分析浆细胞浸润、CAd沉积与体液性排斥反应的相关性。方法切取4o例因排斥反应而丧失功能的移植。肾，取其组织，进行HE染色和免疫组织化学染色，依据Banff 97标准对排斥反应进行病理分型，检测。肾组织中CAd、CD38和CDl38的表达，分析三者之间的相关性。同时以10例非排斥因素导致移植。肾功能丧失者为对照。结果40例排斥反应中，超急性排斥反应5例，急性排斥反应9例，慢性排斥反应26例；40例中，CAd阳性17例（42．5‰），CD38阳性25例（62．5％），CDl38阳性23例（57．5％）；有9例（22．5％）的CAd、CD38和CDl38同时阳性，其中超急性排斥反应1例，急性排斥反应3例，慢性排斥反应5例。经Spearman等级相关分析，CAd的沉积与CD38和CDl38的表达存在相关性（P〈0．05，P〈0．01）。10例对照者中，C4d和CD38染色阳性各1例，无CAd、CD38和CDl38均阳性的病例。结论CD38和CDl38与CAd的沉积存在相关性，提示移植肾中聚集性浸润的浆细胞可能通过局部分泌抗体的方式参与移植肾的体液排斥机制。Objective To detect the deposition of peritubular capillary C4d and the infiltration of plasmocytes in the excised renal allograft and study the correlations among CAd deposition, plasmocytes infiltration and the humoral rejection. Methods Excised renal allografts from 40 patients were embedded,deparaffined, stained with HE and analyzed by immunohistochemistry （IH）. At the same time, 10 excised renal specimens with other diseases were taken as the negative controls. The renal allograft rejection was classified according to the criteria from Banff 97. The expression of CD38 and CD138 was detected,and the relativities among the three markers were evaluated. Results Among the 41） renal allografts specimens,C4d was positive in 17 cases, CD38 positive in 25 cases, CD138 positive in 23 cases,and triple positive in 9 cases with the percentage being 42. 5%,62. 5%,57. 5 %,and 22. 5% respectively. Among the triple positive cases, there were 3 cases of acute cellular rejection, one case of hyperacute rejection, and 5 cases of chronic humoral rejection. The Spearman analysis revealed the relativity of CAd deposition with the expression of CD38 and CD138 （P〈0. 05 and P〈0.01）. In the control group, there was one case positive for CAd and one case positive for CD38 respectively. Conclusion There was relativities of CAd deposition with the expression of CD38 and CD138,suggesting the plasmoeytes nodules infiltrated in renal allografts probably participate in the humoral rejection though secreting antibodies locally.

关 键 词：移植 肾 浆细胞 补体4 抗体生成 

分 类 号：R699.2[医药卫生—泌尿科学] R553.04[医药卫生—外科学]