急性排斥移植肾组织嗜酸性粒细胞浸润及C4d沉积

Eosinophil infiltration and peritubular capillary C4d deposition in acute renal allograft rejection

目的:通过观察移植肾PTC C4d沉积和嗜酸性粒细胞浸润与AHR的关系,探讨两者之间的相关性及其在诊断急性体液排斥中的作用。方法:采用间接免疫荧光法检测移植肾组织C4d沉积。26例移植肾PTC C4d弥漫性强阳性染色患者为C4d阳性组,而30例移植肾PTC C4d阴性患者为对照组。光镜下记数移植肾组织嗜酸性粒细胞数。结果:(1)26例C4d阳性患者中经病理诊断为AHR为13例,AHR+ACR为8例,ACR1为3例,ACR2为2例。30例C4d阴性患者中,AHR为1例,AHR+ACR为2例,ACR1为21例,ACR2为6例。与C4d阴性组相比,C4d阳性组难治性排斥患者较多,常需进一步干预性措施,且较多的患者对抗排斥治疗无反应,移植肾失功率高(7/26)。(2)C4d阳性组移植肾浸润嗜酸性粒细胞数亦明显高于C4d阴性组,两组相比差异显著(P<0.01)。C4d阳性无细胞性排斥组移植肾间质浸润嗜酸性粒细胞数与C4d阳性+ACR组相比差异无显著性(P>0.05)。C4d阳性ACR组移植肾间质浸润嗜酸性粒细胞数明显高于C4d阴性ACR组(P<0.05)。结论:移植肾PTC C4d沉积与嗜酸性粒细胞浸润密切相关,两者在肾移植AHR诊断过程中起重要作用。

Objective： To study the correlation between deposition of CAd along peritubular capillaries （PTC） and interstitial eosinophilic infdtration in renal allografts. Methods： Deposition of CAd in kidneys was assayed by indirect immunoflourescence of the renal allograft biopsies. Twenty-six patients were demonstrated strongly diffuse staining of PTC, who were defined as C4d^＋ group, while the biopsies of thirty patients with acute rejection exhibited negative for FIE C4d staining served as the controls, who were defined as C4d^- group. Eosinophils were counted under microscope. Results： The C4d^- group was demonstrated significantly greater interstitial eosinophilic infiltration than did the C4d^- group（ P 〈 0.01 ） ; Neuttophilic （PMN） infiltration of glomenali and PTC was also significandy greater in the C4d^＋ group than in the C4d^- group（ P 〈 0.05 ）. Conclusion： The results indicate a close association between PTC C4d deposition and eosinophilic infiltration and confirm previous observations regarding the correlation of PTC C4d staining and PMN infiltration.