移植肾排异反应的病理及免疫学改变:附56例报告  

Pathological and immunological changes of renal transplant rejection: report of 56 cases

作　　者：隋燕霞[1] 孙涛[2] 赵东利[3] 侯军[4] 李晓峰[1] 杨喆[1] 

机构地区：[1]西安交通大学医学院第一附属医院病理科,陕西西安710061 [2]西安交通大学医学院药理系,陕西西安710061 [3]西安交通大学医学院第一附属医院肿瘤科,陕西西安710061 [4]西安交通大学医学院第一附属医院肾移植科,陕西西安710061

出　　处：《南方医科大学学报》2014年第3期341-344,共4页Journal of Southern Medical University

基　　金：陕西省科技计划项目(2009K17-04)

摘　　要：目的研究移植肾在术后发生排异反应时,肾脏的病理学及免疫学改变。方法回顾性分析了西安交通大学医学院第一附属医院肾移植术后56例经皮肾脏穿刺活检标本的临床病理资料,根据Banff2009分类系统对排异反应进行病理学分类并分析免疫组织化学标记及免疫荧光在排异反应中的表达情况及其意义。结果 56例移植肾穿刺活检标本中超急排异反应1例(1.79%),界线性病变即可疑急性T细胞排异反应8例(14.29%),急性T细胞介导的排异反应12例(21.43%),急性抗体介导的排异反应6例(10.71%),急性T细胞介导合并抗体介导的排异反应2例(3.57%),慢性活动性T细胞介导的排异反应12例(21.43%),慢性活动性抗体介导的排斥反应2例(3.57%),慢性活动性T细胞介导合并活动性抗体介导的排异反应2例(3.57%),无特异性的间质纤维化和小管萎缩8例(14.29%),正常3例(5.36%)。在不同类型的T细胞介导的排异反应中免疫标记物CD3、CD4、CD8、CD20、GrB、perforin的表达情况也不同,且排异反应越重,这些标记物的表达阳性率及强度也越高;在抗体介导的排异反应中免疫标记物C4d均阳性表达。结论移植肾穿刺活检标本的病理形态学特点结合免疫组织化学及免疫荧光的表达情况可以更加及时准确地判断移植肾排异反应的类型,为临床治疗及判断预后提供可靠的病理学及病因学依据。Objective To investigate the pathological and immunological changes of renal grafts in recipients experiencing graft rejection. Methods The clinicopathologic data of 56 renal needle biopsy samples obtained from renal transplant recipients were analyzed retrospectively. The specimens were classified histopathologically according to the Banff 2009 classification system and analyzed by immunohistochemical labeling and immunofluorescence. Results In the 56 recipients, 1 （1.79%） experienced hyperacute rejection, 8 （14.29%） had suspected acute rejection, 12 （21.43%） developed acute T-cell rejection, 6 （10.71%） had acute antibody-mediated rejection, 2 （3.57%） had acute T-cell rejection with acute antibody-mediated rejection, 12 （21.43%） had chronic active T cell-mediated rejection, 2 （3.57%） had chronic active antibody-mediated rejection, 2 （3.57%） had chronic active T cell-mediated rejection with antibody-mediated rejection, 8 （14.29%） had non-specific interstitial fibrosis and tubular atrophy, and 3 （5.36%） had normal graft function. The expression levels of immune markers CD3, CD4, CD8, CD20, GrB and perforin differed with the types of T cell-mediated graft rejection, and the positivity and expression levels of these markers tended to increased with the severity of graft rejection. The expression of C4d was positive in all cases with antibody-mediated graft rejection. Conclusion The pathological characteristics of the renal biopsy specimens and expression levels of the immune markers allow timely and accurate evaluation of graft rejection type to provide a reliable pathological and etiological basis for clinical treatment and prognostic assessment.

关 键 词：肾移植 活检 免疫组织化学 移植排斥 病理 

分 类 号：R699.2[医药卫生—泌尿科学]