移植肾内新生淋巴管检测的临床意义

Clinical implication of monitoring lymphatic neoangiogenesis in renal transplants

目的:探讨移植肾微淋巴管检测在排斥反应的诊断和移植肾病理分型上的临床意义.方法:对77例肾移植患者的134份移植肾组织标本,用Podoplanin单抗二步法免疫组化标记移植肾内淋巴管,计算移植肾内淋巴管密度(LVD),根据不同的病理诊断进行对比分析.结果:肾功能稳定的移植肾组织LVD平均值最低,为1.03±0.31,与其他各组的两两比较均有统计学差异(P<0.05).慢性/硬化性移植肾肾病组LVD平均值最高,为18.35±4.79,与其他各组间的两两比较均有统计学差异(P<0.01).急性细胞性排斥反应与C4d+急性排斥反应比较无统计学差异(P>0.05).结论:检测移植肾内淋巴管增生有助于移植肾排斥反应的临床诊断和预后判断,并指导抗排斥治疗.移植肾淋巴管生成可能参与慢性排斥反应的发生和发展.

AIM： To investigate the clinical implication of moni- toring lymphatic neoangiogenesis in rejection diagnosis and patho- logical typing. METHODS： To identify the lymphatic neoangio- genesis, 134 biopsy specimens from 77 patients were performed on with immunohistochemical staining for anti-podoplanin monoclonal antibody. The lymphatic vessel density （LVD） was calculated and then compared among different specimens according to clinical diagnosis and post-transplantation duration. RESULTS： The lowest mean LVD （ 1.03 ± 0.31 ） was observed in the specimens from transplants with normal function, which differed significantly from other groups （P 〈 0. 05 ）. Compared with other groups, significantly higher mean LVD （ 18. 35 ± 4. 79 ） was recorded in the specimens from transplants with chronic rejection （P 〈0.01 ）. No significant difference in mean LVD was observed between the specimens with acute cellular rejection and CAd positive acute rejection （ P 〉 0.05 ）. CONCLUSION： Monitoring the lymphatic neoangiogenesis is helpful for the clinical diagnosis of rejection and the evaluation of renal transplant prognosis. The lymphatic neoangiogenesis in renal transplants may be involved in the occurrence and development of chronic rejection.