移植肾间质中浸润细胞免疫标记蛋白的变化与急性细胞性排异的关系

Relationship between various immunological markers expressed in renal allograft tissue and acute cellular rejection

观察移植肾发生急性细胞性排异（ＡＣＲ）和无ＡＣＲ时，肾间质浸润细胞中一组标记蛋白的变化，及其与间质浸润ＣＤ４或ＣＤ８细胞的关系。方法选择１７例肾移植患者，定期行移植肾活检，采用ＰＡＰ四层法对一组标记蛋白进行观察。结果无ＡＣＲ的肾组织中，增殖细胞核抗原（ＰＣＮＡ）和ＤＲ蛋白仅轻度增加，原癌蛋白２（Ｂｃｌ２）、ＩＬ２Ｒ和细胞间粘附分子１（ＩＣＡＭ１）的增加不明显。当移植肾出现ＡＣＲ时，上述标记蛋白均明显增加，尤以ＰＣＮＡ和ＩＬ２Ｒ增加最为显著，并与间质浸润的ＣＤ８密切相关。结论移植肾的免疫组化检查对移植肾急性细胞性排异反应有一定的意义；ＩＬ２Ｒ对于ＡＣＲ的诊断及鉴别诊断具有一定的临床应用价值。

Objective To observe the changes of various immunological markers and its relationship with CD4 or CD8 in the renal interstitial infiltrates while acute cellular rejection(ACR) occured and did not occured. Methods 2 to 5 consecutive allograft biopsies were obtained from 17 serial human transplant recipients over an eightmonth period. A total of 59 core needle biopsies were examined. The expression of proliferation cell nucleus antigen (PCNA)、interleukin 2 receptor (IL 2R)、Bcl 2 and intercellular adhesion molecule 1 (ICAM 1) in interstitial infiltrates, as well as the presence of CD4/CD8 T cell infiltrates were assessed by immunocytochemical staining of frozen sections. Results When ACR occured, all the immune activity markers previously mentioned increased in amount in the renal specimens significantly as compared with those specimens without ACR. The degree of increasement for IL 2R (16.3 fold) and PCNA (14.7 fold) was highest, next were ICAM 1 (2.1 fold). After MP pulse therapy the expressions of IL 2R and PCNA in biopsies were evidently down regulated about 60% and 47% respectively. Conclusion The expression of IL 2R and PCNA in renal allograft may be a useful and helpful adjunct in the diagnosis of ongoing acute cellular rejection, and decreases in these expressions may be indicative of successful antirejection therapy.