多瘤病毒相关性肾病患者肾组织浸润细胞的变化及意义  

Immunohistological features of polyomavirus type BK associated renal allograft nephropathy

作　　者：陈劲松[1] 陈惠萍[1] 文吉秋[1] 程东瑞[1] 季曙明[1] 谢轲楠[1] 倪雪峰[1] 李雪[1] 刘志红[1] 

机构地区：[1]南京军区南京总医院肾脏科,国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2015年第2期128-132,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04)(2015BAI12B05);江苏省临床医学中心项目(BL2012007)

摘　　要：目的:观察肾移植术后多瘤病毒相关性肾病(BKVAN)患者肾组织浸润细胞的变化,探讨其临床意义。方法:28例BKVAN患者作为研究对象(BKVAN组),选取26例急性排斥反应和19例常规活检患者作为对照组。比较BKVAN组与对照组肾组织中CD4^+、CD8^+、CD68^+、CD20^+细胞,白细胞介素2受体(IL-2R)的阳性表达及肾小管上皮细胞HLA-DR的阳性表达情况;根据血清肌酐(SCr)水平将BKVAN患者分为A1组11例(109.62<SCr≤219.23μmol/L)、A2组11例(219.23<SCr≤328.85μmol/L)和A3组6例(SCr>328.85μmol/L),观察不同SCr水平BKVAN患者移植肾组织中上述指标的变化。结果:BKVAN肾组织中CD4^+、CD8^+、CD68^+、CD20^+细胞、IL-2R的阳性表达较常规活检组均明显增加(P<0.01),而肾小管上皮细胞HLA-DR的阳性表达增加不明显;BKVAN组与急性排斥反应组相比,前者肾组织中B淋巴细胞浸润数量增加,但统计学差别不明显,而急性排斥反应组CD8^+细胞和肾小管上皮细胞HLA-DR的阳性表达显著增加(P<0.01)。随着SCr水平的升高,BKVAN患者移植肾组织中CD68^+细胞、IL-2R的阳性表达增加,其中A3组与A1组相比CD68^+细胞的浸润具有显著统计学差别(P<0.01)。结论:BKV诱发肾组织T淋巴细胞和B淋巴细胞活化,加重移植肾损害;与急性排斥相比BKVAN组受者肾组织中CD20^+细胞的浸润数量更多、肾小管上皮细胞HLA-DR阳性表达和CD8^+细胞明显减少。Objective：To investigate the immunohistological features of poiyomavirus type BK associated renal allograft nephropathy （BKVAN）. Methodology： Seventy three patients with renal transplantation were selected in this retrospective study. They included 28 cases with BKVAN （BKVAN group）, 26 cases with acute rejection （control group 1 ） and 19 cases with normal biopsy （control group 2）. By immunohistochemistry ways, the difference of CD4, CDS, CD68, B lymphocyte and T lymphocyte interleukin-2 receptor （IL-2R） expressed in renal allograft biopsy and HLA-DR expressed in renal allograft tubular epithelial cell were observed among BKVAN group, control group 1 and control group 2. On the basis of serum creatinine（SCr） level, 28 patients with BKVAN were devided into group A1 （ 109. 62〈SCr≤219. 23 μmmol/L, n = 11 ）, group A2 （ 219〈SCr≤328.85 μmmol/L, n = 11 ） and group A3 （ SCr〉328.85 μmmol/L, n = 6）. The differences of IL-2R and HLA-DR were also observed among three groups . Results：The levels of CD4, CD8, CD68, B lymphocyte and T lymphocyte IL-2R were significantly increased in BKVAN group than those in the control group 2 （P〈0. 01 ）, while the expression of HLA-DR in renal allograft tubular epithelial cell was not different. Although the number of B lymphocyte was arithmetically greater in BKVAN group than that in the control group 1, the difference was not statistically significant. The expression of HLA-DR in renal allograft tubular epithelial cell and the levels of CD8 were significantly increased in control group 1 compared to BKVAN group （P〈0. 01）. With the elevated SCr level, the levels of CD68 and T lymphocyte IL-2R were moreincreased in BKVAN group, and there were significant differences between the group A3 and A1 （P〈0. 01）. Conclusion： Renal allograft damage caused by BKVAN involved in both T and B lymphocyte mediated immune responses. BKVAN was characterized by the more B lymphocytes, not more expressed HLA-DR in renal allograft tubular e

关 键 词：肾移植 多瘤病毒相关性肾病 病理组织学 

分 类 号：R699.2[医药卫生—泌尿科学]