体液免疫在移植肾慢性排斥中作用  

The role of humoral immunity in chronic rejection following renal transplantation

作　　者：吴家清[1] 赵明[1] 李留洋[1] 张敏[1] 蔡瑞明[1] 

机构地区：[1]南方医科大学珠江医院器官移植科,广东省广州市510282

出　　处：《中国组织工程研究与临床康复》2009年第18期3437-3441,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省自然科学基金项目(06024438)~~

摘　　要：背景:由于群体反应性抗体是引起体液性排斥反应的主要抗体,目前国外研究的最多,国内较少见有关群体反应性抗体和C4d在慢性体液排斥反应中作用的报道,目的:通过检测移植肾组织C4d表达及群体反应性抗体分布,观察体液免疫在肾移植后慢性排斥中的作用。设计、时间及地点:病例对比分析,病例来自2006-01/2007-12南方医科大学珠江医院器官移植科。对象:选择经移植肾穿刺活检确诊(依照Banff97标准)为慢性排斥的患者36例作为慢性排斥组,男27例,女9例,平均年龄(43.17±12.18)岁。随机抽取移植肾功能正常门诊随访的106例受者作为对照组,男51例,女55例,平均年龄(43.33±9.50)岁。两组患者肾移植均在1年以上。方法:慢性排斥组移植肾穿刺标本做C4d免疫组织化学染色,酶联免疫吸附法检测两组移植后血群体反应性抗体。主要观察指标:分析慢性排斥组内C4d的表达及其与群体反应性抗体分布的关系、群体反应性抗体在慢性排斥组和对照组间的差异。结果:①36例慢性排斥患者中,19例C4d在移植肾管周毛细血管沉积,阳性率为53%,C4d沉积与慢性排斥特征性病理形态显著相关(P<0.01);C4d阳性患者移植后群体反应性抗体阳性率明显高于C4d阴性患者(P=0.001)。②慢性排斥组移植后群体反应性抗体阳性率明显高于对照组(P<0.001);移植前群体反应性抗体阴性、移植后转为阳性者比率也明显高于对照组(P<0.001);两组移植前群体反应性抗体阳性率差异无显著性意义(P=0.939)。结论:肾移植后慢性排斥中半数以上存在体液性排斥,移植后血群体反应性抗体和移植肾组织C4d检测可及早明确慢性体液免疫损害的存在。BACKGROUND： The panel reactive antibody （PRA）, which is the main antibody in humoral rejection, has attracted more attention. However, reports regarding the role of PRA and complement4-d （C4d） in humeral rejection are few. OBJECTIVE： To investigate the effect of hummoral immunity in chronic rejection by detecting C4d expression and panel reactive antibody （PRA） distribution following renal transplantation. DESIGN, TIME AND SETTING： A contrast analysis of patients was performed at the Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University from January 2006 to December 2007. PARTICIPANTS： Totally 36 cases who were diagnosed as chronic rejection according to Banff97 standard was served as chronic rejection group, including 27 male and 9 female, aged （43.17_＋12.18） years old. Other 106 recipients with normal allograft function were randomly selected and served as control group, with 51 male and 55 female, aged （43.33±9.50） years old. All cases were over 1 year after renal transplantation. METHODS： The C4d depositions in allograft biopsies of chronic rejection group were detected by immunohistochemisty and the PRA in blood was detected by ELISA. MAIN OUTCOME MEASURES： The expression of C4d and its correlation to PRA distribution, as well as differences of PRA between chronic rejection group and the control group were analyzed. RESULTS： ①In 36 cases of the chronic rejection group, 19 cases were showed C4d deposits in peritubular capillaries （PTC）, with 53% positive rate. C4d deposits were obviously associated with pathognomonic changes after chronic transplantation （P 〈 0.01 ）. 4d（＋）/PRA（＋） cases were obviously greater than C4d（-）/PRA（＋） （P=0.001）. ②The positive ratio of PRA post-transplantation in chronic rejection group was significantly higher than that of control group （P 〈 0.001）, the positive ratio of PRA developed after transplantation in chronic rejection group was also significantly higher

关 键 词：慢性排斥 体液免疫 补体4片断 群体反应性抗体 

分 类 号：R617[医药卫生—外科学]