肾移植急性排斥患者肾组织C4d的沉积及其意义  

Peritubular capillary C4d deposition in acute renal allograft rejection

作　　者：刘志红[1] 陈书芬[1] 陈朝红[1] 曾彩虹[1] 周虹[1] 陈劲松[1] 唐政[1] 黎磊石[1] 

机构地区：[1]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2003年第5期415-418,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :探讨肾组织C4d的沉积在诊断移植肾急性排斥反应 (AR)、指导治疗和判断预后中的作用。　方法 :选择 6 6例肾移植AR患者 ,其中急性间质性排斥 (AIR) 30例 ,急性血管性排斥 (AVR) 36例 ,应用间接免疫荧光法检测肾组织中C4d的沉积 ,并与临床表现、移植肾组织病理改变及治疗和预后的关系进行分析。　 结果 :①正常肾组织肾小管周毛细血管无C4d的沉积。AVR患者肾小管周毛细血管C4d沉积的阳性率明显高于AIR患者 (5 6 %vs6 7% ,P <0 0 1)。②在C4d阳性AVR患者中 ,女性患者明显高于C4d阴性患者 (P <0 0 5 )。群体反应性抗体水平升高的发生率 ,C4d阳性患者也明显高于阴性者 (45 %vs1 2 % ,P <0 0 5 )。③AVR患者C4d阳性者移植肾功能延迟恢复(46 %vs13% ,P <0 0 5 )和移植肾失功的发生率 (35 %vs6 3% ,P <0 0 5 )均明显高于C4d阴性者。④ 4例C4d阳性AVR患者在接受抗排斥治疗后 ,有 3例患者肾功能恢复正常 ,重复肾活检显示肾组织C4d沉积亦随之消失。　 结论 :移植肾组织C4d沉积的发生与排斥反应的类型有关 ,体液免疫反应亢进者发生率高。存在致排斥发生高危因素者发生率高。AR伴肾组织C4d沉积者预后不佳。积极有效的治疗能在逆转病情的同时 ,使肾组织C4d的沉积随之消失。Objective:To explore the significance of peritubular capillary C4d deposition in the diagnosis, treatment and prognosis of the patients with acute renal allograft rejection. Methodology:C4d was detected by indirect immunofluorescence method in renal tissues obtained from allograft biopsies. Thirty six patients with acute vascular renal allograft rejection (AVR) and 30 patients with acute interstitial renal allograft rejection (AIR) were enrolled in this study. Results:① The frequence of peritubular capillary C4d deposition was significantly higher in patients with acute vascular renal allograft rejection than those with acute interstitial renal allograft rejection (56% vs 6 7%, P <0 01). ② C4d deposition associated with more female patients ( P <0 05) and higher positive frequence of panel reactive alloantibodies (45% vs 1 2%, P <0 05). ③ The grafts experienced with delayed function (46% vs 13%, P <0 05) and grafts loss (35% vs 6 3%, P <0 05) were both more frequent in patients with C4d deposition. ④ Repeat allograft biopsies demonstrated that after effective immunosuppressive therapy, the deposition of C4d disappeared, followed the recovery of renal function. Conclusion:Peritubular capillary C4d deposition could be considered as a marker of humoral immunity in renal allograft rejection. Patients with the high risk factors of allograft rejection demonstrated a higher frequency of C4d deposition. Peritubular capillary C4d deposition associated with the bad prognosis of allograft function. Detection of C4d deposition in renal allograft is a useful tool in the diagnosis of humoral rejection, selection of therapeutic regimens and prediction the prognosis of renal allograft.

关 键 词：肾移植 急性排斥反应 肾组织 C4D 临床意义 间接免疫荧光法 预后 

分 类 号：R699[医药卫生—泌尿科学]