移植肾临界改变的免疫病理研究

IMMUNOHISTOCHEMICAL FEATURES OF “BORDERLINE CHANGES”IN CADAVERIC KIDNEY TRANSPLANTATION

目的：观察临界改变的移植肾组织免疫病理变化与正常移植肾和急性排斥间的差异，分析不同临床表现患者的免疫病理特点。 方法：免疫组化方法检测２２ 例临界改变，２０ 例正常移植肾及１５ 例急性排斥肾间质浸润的ＣＤ４＋ 、ＣＤ８ ＋ ，ＰＣＮＡ＋ 和ＣＤ２５ ＋ 细胞，以及皮质肾小管ＤＲ 和ＩＣＡＭ１ 蛋白的表达。以单位面积内计数的方法对皮质间质浸润的细胞及ＤＲ＋ 和ＩＣＡＭ１＋ 小管数进行半定量测定。 结果：２２ 例诊断为临界改变的患者中，１４ 例肾功能正常，８ 例有肾功能异常。肾功能异常者与肾功能正常者的临界改变，其组织形态学差异不显著。临界改变多发生于术后３ 个月内（２０／２２ 例） 。临界改变肾组织免疫病理表现为：①肾间质中浸润的ＣＤ４ ＋ 、ＣＤ８ ＋ 、ＰＣＮＡ＋ 及ＣＤ２５ ＋ 细胞数均高于正常移植肾但是低于急性排斥。②肾皮质ＤＲ＋ 小管数显著多于正常移植肾，但是与急排肾皮质区ＤＲ＋ 小管数之间无差异；③皮质ＩＣＡＭ１＋ 小管数与正常相近，急排的ＩＣＡＭ１ ＋ 小管数明显增加，与临界改变相比差异非常显著。 结论：临界改变肾组织中，ＣＤ４＋ 、ＣＤ８＋ 、ＰＣＮＡ＋ 及ＣＤ２５ ＋ 细胞数介于正常与急性排斥之间。其小管ＤＲ

To examine the immunohistochemical features in renal allograft biopsy sections of borderline changes patients,and to evaluate the relationship between immunohistochemical and clinical features in recipients of cadaveric kidney transplantation. METHODOLOGY We reviewed the clinical and immunohistochemical data in 22 patients with borderline change,and compared them to 20 recipients with normal allograft function and 15 patients with acute rejection.PAP four layer immunohistochemical staining was applied in the detection of CD4 +,CD8 +,PCNA,CD25 + cell infiltration and ICAM 1,HLA DR protein synthesis.All biopsies were systematically evaluated according to BANFF schema. RESULTS 20 of the 22 patients with “borderline changes”were diagnosed within 3 months after transplantation.In “borderline changes”biopsies,there were more infiltrating CD4 +,CD8 +,PCNA + and CD25 + cells than those in normal allografts,but still significantly less than those in allografts with acute rejection.Among all of the infiltrating cells,PCNA + cell infiltration increased most prominently in acute rejection.Compared to normal allografts,HLA DR protein production in cortical tubular cells was found greatly elevated in allografts of “borderline changes”,which was similar to that in acute rejection,while ICAM 1 production was found only slightly increased in allografts of “borderline changes”,which was significantly lower than that in acute rejection. CONCLUSION Borderline change renal allograft had distinct immunohistochemical featrues as compared to normal allograft change or acute rejection.