肝脏移植急、慢性排斥反应时移植肝内B淋巴细胞和浆细胞的变化和意义

Roles of B lymphocyte and plasma cell in liver allograft of acute and chronic rejection

目的 探讨B淋巴细胞和浆细胞与肝脏移植排斥反应的关系,寻找体液因素参与排斥反应的相关证据.方法 检测25例肝脏移植术后肝损害受者的34次肝脏穿刺标本及其术前供肝标本中补体C4d、CD20＋B细胞和CD138＋浆细胞的表达情况,分别比较急、慢性排斥反应及非排斥反应病例上述成分的变化情况及不同程度肝损伤情况下的阳性率的差异,同时观察CD20＋B细胞和CD138＋浆细胞的表达与C4d沉积的关系,并结合临床,比较B细胞和浆细胞不同表达情况下治疗的预后.结果 急性排斥反应组CD20＋B细胞和CD138＋浆细胞阳性率均明显高于非排斥反应组（P〈0.05和P〈0.01）;慢性排斥反应组CD20＋B细胞阳性率高于非排斥反应组（P〈0.05）,CD138＋B浆细胞阳性率两组间无明显差异;重度肝损伤组CD20＋B细胞阳性率明显高于轻度肝损伤组（P〈0.05）;不同程度肝损伤情况下CD138＋浆细胞阳性率无明显差异,同时实验发现,CD20＋B细胞和CD138＋浆细胞与C4d基本同时表达（P〈0.01和P〈0.05）.三种成分同时阳性病例激素治疗的敏感率明显低于同时阴性病例（P〈0.05）.结论 体液因素可能参与了部分肝脏移植排斥反应的发生;将CD20、CD138、C4d同时作为肝脏移植术后肝损害时肝穿病理的常规免疫组化项目,可以监测和预警体液性排斥反应的发生,为选择纠正排斥反应的治疗方案提供依据.

Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20＋ B lymphocytes and CD138＋ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20＋ B lympho-cytes and CD138＋ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20＋ B lymphocytes and CD138＋ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20＋B lymphocytes and CD138＋ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group（P〈0. 05 and P〈0. 01）.The positive ratios of CD20＋ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group（P〈0. 05）. There was no difference in CD138＋ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138＋ plasma, but the positive ratioes of CD20＋ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups（P〈0. 05）. CD20＋ B lymphocytes and CD138＋ plasma cells presented fol-lowing C4d（P〈0. 01 and P〈0. 05）. The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group（P〈0. 05）. Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.