肾脏HLA－DR抗原表达在肾移植中的意义

EXPRESSION OF HLA-DR ANTIGEN IN RENAL ALLOGRAFTS

应用免疫酶标技术对４７例异体肾移植患者的９５例次肾活检标本进行ＨＬＡ－ＤＲ抗原检测，同时做光镜、电镜、免疫病理检查及淋巴细胞亚群的研究。结果显示，肾移植后肾近曲小管上皮细胞的ＤＲ抗原表达增加，肾小球的ＤＲ表达减少；急、慢性排斥反应与急性肾小管坏死时，肾小管及肾间质的ＤＲ抗原表达均明显增加；环孢素中毒时，肾单位的ＤＲ抗原表达正常，肾间质的ＤＲ抗原表达增加。肾脏ＨＬＡＤＲ抗原表达在肾移植后的变化用于排斥反应的诊断、鉴别诊断、判断预后及治疗决策具有重要意义。

HLA-DR antigen expression was assayed with monoclonal antibody and indirect im- munoperoxidase technique in 95 renal allografts in 47 patients, The results showed that the HLA-DR ex- pression on proximal tubules increased after kidney transplantation and was at much higher in patients with acute or chronic rejection and acute tubular necrosis (ATN)compared with those with“well-to-do” transplant. However, the patients with cyclosporin(CsA ) nephrotoxicity displayed similar expression of HLA-DR on tubules of 'apparently good'grafts. Institial HLA-DR expression was very high in all the above-mentioned conditions including rejection, ATN and CsA toxicity. It is concluded that the analysis of HLA-DR antigen expression in renal allografts is of value in the differential diagnosis of rejection , ATN and CsA nephrotoxicity.