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目的:观察CD20+细胞浸润与肾移植急性排斥反应发生时间以及预后的关系。方法:收集2003年5月至2008年12月经肾活检明确诊断为急性细胞性排斥反应的患者55例,按急性排斥发生时间分极早期组17例(<2周),早期组16例(2周～6月),晚期组22例(>6月)。所有入组患者移植肾活检组织除行光镜检查外,均采用免疫组化法行肾组织CD4,CD8,CD20,CD68和HLA-DR检查,并采用定量分析评估不同时间急性排斥反应肾组织中各种细胞浸润程度。随访中位期≥48月,将所有急性排斥患者和两周后发生的急性排斥反应患者依CD20+细胞浸润程度分为CD20+细胞高密度组和低密度组,分析两组患者移植肾预后。结果:极早期组中CD20+细胞密度较早期组和晚期组低,而CD4,CD8,CD68和HLA-DR在各组之间无明显差别;(CD4+CD8)/CD20的比值在极早期组中高于早期组和晚期组。对所有急性排斥反应患者分析,CD20+细胞高密度组的移植肾预后较低密度组差(P<0.05)。CD20+细胞高密度组和低密度组之间肾小球炎、动脉内膜炎、间质浸润、CD4、CD8、CD68和HLA-DR表达无差别,而高密度组肾小管炎程度高于低密度组,低密度组中极早期排斥反应比例高于高密度组。在两周后发生急性排斥反应的患者中,CD20+细胞高密度组和低密度组的移植肾预后无差别(P>0.05)。结论:CD20+细胞聚集很少在两周内发生的急性排斥反应中出现,而多出现在两周后发生的急性排斥反应中。移植肾预后跟单纯CD20+细胞浸润程度无相关性,而与排斥反应发生时间有关。
Objective: To observe the relationship between the infiltration of CD20 + cells and the time of acute rejection and the prognosis of renal allograft. Methods: From May 2003 to December 2008, 55 patients with acute cellular rejection who were confirmed by renal biopsy were enrolled. According to the time of acute rejection, 17 patients (<2 weeks) Week ~ June), advanced group of 22 patients (> June). All patients underwent renal biopsy except for light microscopy, the immunohistochemical method was used to detect the expression of CD4, CD8, CD20, CD68 and HLA-DR in renal tissue, and quantitative analysis was used to evaluate the effect of different time on acute rejection The degree of various cell infiltration. The median follow-up ≥ 48 months, all patients with acute rejection and patients with acute rejection after two weeks according to the degree of CD20 + cell infiltration were divided into high-density group and low-density group CD20 + cells, the two groups of patients with renal transplant prognosis. Results: The density of CD20 + cells in the very early group was lower than those in the early group and the late group, while there was no significant difference in the CD4, CD8, CD68 and HLA-DR between the groups. The ratio of (CD4 + CD8) / CD20 In the early and late groups. For all acute rejection patients, CD20 + cells in high-density group had lower graft-versus-density renal density (P <0.05). There was no difference in glomerular inflammation, endarteritonitis, interstitial infiltration, CD4, CD8, CD68 and HLA-DR expression between high-density and low-density groups in CD20 + cells, while high density group had higher degree of renal tubulitis than low density In the low density group, the proportion of very early rejection was higher than that in the high density group. Among the patients who developed acute rejection two weeks later, there was no difference in the prognosis of transplant recipients between CD20 + cells in high-density and low-density groups (P> 0.05). CONCLUSIONS: CD20 + cell aggregation rarely occurs within two weeks of acute rejection but occurs more frequently in acute rejection two weeks later. There is no correlation between the prognosis of renal allograft and the degree of infiltration of CD20 + cells, but it is related to the time of rejection.