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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。移植肾组织C4d检测对于提高排斥
Objective: To investigate the role of C4d deposition in the diagnosis of acute renal allograft rejection (AR), treatment and prognosis. Methods: Sixty-six AR patients with renal allograft were selected, including 30 cases of acute interstitial rejection (AIR) and 36 cases of acute vascular rejection (AVR). Indirect immunofluorescence was used to detect the deposition of C4d in renal tissues. , Pathological changes of renal transplantation and the relationship between treatment and prognosis. Results: ① There was no C4d deposition in the peritubular capillaries of normal kidneys. The positive rate of peritubular capillary C4d deposition in AVR patients was significantly higher than that in AIR patients (56% vs 67%, P <0.01). ② In C4d-positive AVR patients, the female patients were significantly higher than the C4d negative patients (P <0 05). The incidence of elevated level of reactive antibody in patients with C4d was also significantly higher than that of negative patients (45% vs 12%, P <0 05). ③ The delayed graft recovery (46% vs 13%, P <0 05) and graft failure (35% vs 63%, P <0 05) in C4R positive patients with AVR were significantly higher than those with C4d negative . ④ After 4 cases of C4d-positive AVR patients received anti-rejection therapy, renal function returned to normal in 3 cases. Repeated renal biopsy showed disappearance of C4d deposits in renal tissues. Conclusion: The occurrence of C4d deposition in renal allografts is related to the type of rejection and the incidence of humoral immune response is high. There is a high incidence of rejection risk factors. AR with renal C4d deposition poor prognosis. Active and effective treatment can reverse the disease at the same time, so that the deposition of kidney C4d disappear. Transplantation of kidney C4d test to improve rejection