慢性移植物肾病组织补体C4d沉积的意义

Peritubular capillary C4d deposition in chronic allograft nephropathy

目的探讨慢性移植物肾病中补体C4d的沉积及其意义。方法选择慢性移植物肾病活检标本(C A N组,n=28),应用免疫组化和间接免疫荧光法检测C4d在移植肾组织中的沉积,比较其与正常移植肾组织(对照组,n=10)间的差异。结果对照组肾小管周毛细血管无C4d的沉积,但肾小球系膜区、基底膜和肾小管基膜上有C4d的弥漫沉积,部分动脉内膜也有C4d的沉积。C AN组8例(29%)出现管周毛细血管内皮细胞C4d的线性沉积,而肾小球毛细血管少见C4d的沉积(1/28,4%)。间接免疫荧光法显示C4d弥漫性沉积,主要见于管周毛细血管内皮细胞。结论补体的活化导致裂解片断的沉积,慢性移植物肾病中出现肾组织C4d的沉积,体液免疫可能是导致慢性移植肾损伤的一个原因。

To investigate the capillary deposition of complement split product C4d in chronic allograft nephropathy (CAN). Biopsy transplanted renal specimens from 28 cases diagnosed as CAN (CAN group) and from 10 cases without CAN (control group) were used to detect C4d deposition by immunohistochemistry and indirec t immunofluorescence method. In control group C4d deposition was not found at peritubular capillary but in glomerulus basement membrane and renal tubular basement membrane. Some tunica intima of artery also had C4d deposition. Immunohistochemistry results showed in CAN group C4d linear deposition in peritubular capillary, but little in glomerulus capillary. And indirect immunofluorescence method showed linear C4d deposition, mainly along endothelia cells of peritubular capillary. [Conclusion] The activation of complement leads to deposition of complement split products, deposition of C4d in chronic rejection renal allograft shows humoral immunity may be a cause which can lead to chronic renal allograft injury.