移植肾内微淋巴管生成特点及其临床病理意义

Characteristic and clinicopathologic significance of lymphangiogenesis in kidney transplants

目的探讨移植肾内微淋巴管生成的病理特点及其与排斥反应的关系。方法对67例肾移植患者的104份存档移植肾组织标本，用肾小球足细胞黏蛋白单抗二步法免疫组化标记移植肾微淋巴管，观察微淋巴管形态学及分布特点，计算淋巴管密度（LVD），并根据不同病理学诊断进行比较。结果（1）形态学观察示功能稳定的移植肾组织中微淋巴管数量较少，重度急性排斥反应的移植肾内微淋巴管管腔大小不等，多分布在末梢小动脉周围，慢性／硬化性移植肾肾病的微淋巴管数明显增多，管腔扩张，扭曲，其周围多见局灶性单核细胞浸润。（2）正常肾组织、肾功能稳定的移植肾组和移植肾药损害组中LVD平均值较低，分别为1．03±0．31、1．76±0．52和1．87±1．13，其两两比较差异无统计学意义（均P〉0．05）。急性细胞性排斥组、CAd^＋急性排斥组和慢性／硬化性移植肾肾病组LVD平均值分别为3．33±0．92、3．56±1．12和18．35±4．79。与肾功能稳定的移植肾组的比较差异有统计学意义（均P〈0．01）。

Objective To investigate the Characteristic and clinicopathologic significance of lymphangiogenesis in kidney transplants and their relationship with renaltransplant rejection. Methods Monoclonal podoplanin was used to irnmunostain the lymphatic microvessels in the 104 paraffin sections of renal transplant biopsies from 67 cases kept in the archives. The morphologic characterization and distribution of lymphatic microvessels, and the lymphatic vessel density （LVD） were compared between normal kidneys and grafts with different pathologic diagnosis. Results （1） No significant proliferation of lymphatic microvessels was observed in normal function renal grafts, and their location and number resembled that of normal kidneys. In the severe acute rejection kidney, lymphatic microvessels were variably larger, and denser confined to the adventifia of small-sized arteries. Numerous podoplanin-expressing lymphatic capillaries and larger caliber vessels are found within and around nodular mononuclear stromal infiltrates in the kidney transplants with chronic/sclerosing allograft nephropathy. （2） The LVD of normal kidney, stable function renal grafts and renal grafts with calcineurin inhibitor toxicity were 1.03 ± 0. 31, 1.76 ± 0. 52 and 1.87 ± 1.13 respectively, there were not significant differences among this three groups （P 〉 0. 05）. The LVD in acute rejection group, C4d^＋ acute rejection group and chronic/sclerosing allograft nephropathy group were 3. 33 ± 0. 92, 3.56 ±1.12 and 18.35 ±4.79 respectively, all significantly higher than that in stable function group （ P 〈 0. 01,0. 01,0. 01 ）. Conclusions There are varied pathologic characterizations between different grading of rejection. The degree of lymphangiogenesis in renal grafts may be associated with pathologic grading of rejection.