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目的 :探讨免疫组织化学EnVision方法在移植肾功能减退患者肾组织中检测环孢素A(CsA)的可能性及其意义。 方法 :收集我院 1988年至 1998年间肾移植术后长期服用CsA、血肌酐增高 ,临床表现为移植肾功能减退的患者 11例 ,在B超引导下从移植肾上极、下极穿刺活检 ,正常肾组织作为对照组。采用免疫组织化学染色技术检测CsA及多药耐药P gp蛋白在移植肾组织中的表达 ,观察其在组织切片中的形态学变化。 结果 :本组 11例肾移植患者中 ,有 8例 (72 7% )CsA阳性 ,对照组CsA为阴性 ;CsA以肾小管阳性率最高 (72 7% ) ,小血管次之 (45 5 % ) ,肾小球最低 (2 7 3% )。P gp在移植肾组织中也以肾小管表达最高 (81 8% ) ,小血管次之 (2 7 2 % ) ,肾小球最低 (18 1% )。CsA和P gp在移植肾组织中表达具有一致性 ,二者同时阳性以肾小管最高 ,共 7例(6 3 6 % )。患者血中环孢素浓度超过正常值的次数 ,与环孢素在移植肾组织中的阳性率不一致。肾移植后时间的长短与移植肾组织中CsA和P gp表达程度不相关。 结论 :检测移植肾肾组织中CsA的表达 ,有可能成为肾移植术后监测CsA肾毒性的一个重要指标 ,而同时检测多药耐药P gp蛋白在移植肾组织中的表达 ,则可以提高诊断准确性。
Objective: To investigate the possibility and significance of EnVision immunohistochemistry in the detection of CsA in renal tissues of patients with impaired renal function. Methods: A total of 11 patients with long-term CsA, elevated serum creatinine and renal allograft dysfunction after renal transplantation were collected from 1988 to 1998 in our hospital. From the upper pole and the inferior pole of the renal graft under biopsy, Normal kidney tissue served as control group. Immunohistochemical staining was used to detect the expression of CsA and multidrug-resistant P gp protein in renal allograft. Morphological changes in the tissue sections were observed. Results: Among the 11 renal transplant recipients, 8 (72.7%) had CsA positive and CsA was negative in the control group. The positive rate of renal tubules was 72.7% in CsA group, followed by 45.5% , Glomerular lowest (273%). Pgp also showed the highest tubular expression (81.8%), small vessel second (272%) and glomerular (18.1%) in renal allograft. The expression of CsA and P gp in renal allograft was consistent, both of them were the highest in renal tubules, a total of 7 cases (666%). Cyclosporine concentrations in patients with blood over the normal number of times, and cyclosporine in renal transplant positive rate is inconsistent. The length of time after kidney transplantation was not correlated with the expression of CsA and P gp in renal allograft. CONCLUSION: Detecting the expression of CsA in renal allograft may be an important indicator of nephrotoxicity after renal transplantation, while detecting the expression of multidrug resistant gp protein in renal allograft can improve the diagnosis accuracy.