中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2010年
11期
651-653
,共3页
李民%刘永光%蔡瑞明%郭颖%赵明
李民%劉永光%蔡瑞明%郭穎%趙明
리민%류영광%채서명%곽영%조명
肾移植%补体C4d%慢性移植肾肾病%免疫,体液
腎移植%補體C4d%慢性移植腎腎病%免疫,體液
신이식%보체C4d%만성이식신신병%면역,체액
Kidney transplantation%Complement C4d%Chronic allograft nephropathy%Immunity,humoral
目的 探讨移植肾组织中补体C4d沉积在慢性移植肾肾病(CAN)的诊断和治疗中的临床意义.方法 将2000年1月至2008年8月间诊断为CAN,且已行移植肾活检,并能收集到活检后2年以上随访资料者纳入研究.符合标准者共有86例,其中男性53例,女性33例,移植时年龄18～65岁.应用免疫组织化学染色方法检测移植肾组织活检标本C4d的表达.所有患者在行移植肾穿刺诊断为CAN后均给予了常规治疗.结果 86例患者中,C4d沉积阳性者(C4d阳性组)39例,C4d沉积阴性者(C4d阴性组)47例,两组患者在性别、年龄、供肾来源、多次移植、移植时群体反应性抗体水平等各指标的比较,差异均无统计学意义(P＞0.05).活检2年后,C4d阳性组和阴性组患者的SCr水平分别为(551.5±140.4)和(443.0±133.1)μmol/L,两组比较,差异有统计学意义(P＜0.05);并且C4d阳性组患者移植肾功能丧失率(23.1%,10/39)也显著高于C4d阴性组(8.5%,4/47),两组比较,差异有统计学意义(P＜0.05).CAN治疗前,C4d阳性组发生高血压和高血脂者多于阴性组(P＜0.05);常规治疗后,剔除移植肾功能丧失者,两组间发生高血压、高血脂、高血糖和高血尿酸者差异无统计学意义(P＞0.05).结论 C4d阳性的CAN患者提示有慢性体液排斥反应的参与,临床常规治疗预后较差,若针对体液免疫反应进行干预,能够改善移植肾长期存活.
目的 探討移植腎組織中補體C4d沉積在慢性移植腎腎病(CAN)的診斷和治療中的臨床意義.方法 將2000年1月至2008年8月間診斷為CAN,且已行移植腎活檢,併能收集到活檢後2年以上隨訪資料者納入研究.符閤標準者共有86例,其中男性53例,女性33例,移植時年齡18～65歲.應用免疫組織化學染色方法檢測移植腎組織活檢標本C4d的錶達.所有患者在行移植腎穿刺診斷為CAN後均給予瞭常規治療.結果 86例患者中,C4d沉積暘性者(C4d暘性組)39例,C4d沉積陰性者(C4d陰性組)47例,兩組患者在性彆、年齡、供腎來源、多次移植、移植時群體反應性抗體水平等各指標的比較,差異均無統計學意義(P＞0.05).活檢2年後,C4d暘性組和陰性組患者的SCr水平分彆為(551.5±140.4)和(443.0±133.1)μmol/L,兩組比較,差異有統計學意義(P＜0.05);併且C4d暘性組患者移植腎功能喪失率(23.1%,10/39)也顯著高于C4d陰性組(8.5%,4/47),兩組比較,差異有統計學意義(P＜0.05).CAN治療前,C4d暘性組髮生高血壓和高血脂者多于陰性組(P＜0.05);常規治療後,剔除移植腎功能喪失者,兩組間髮生高血壓、高血脂、高血糖和高血尿痠者差異無統計學意義(P＞0.05).結論 C4d暘性的CAN患者提示有慢性體液排斥反應的參與,臨床常規治療預後較差,若針對體液免疫反應進行榦預,能夠改善移植腎長期存活.
목적 탐토이식신조직중보체C4d침적재만성이식신신병(CAN)적진단화치료중적림상의의.방법 장2000년1월지2008년8월간진단위CAN,차이행이식신활검,병능수집도활검후2년이상수방자료자납입연구.부합표준자공유86례,기중남성53례,녀성33례,이식시년령18～65세.응용면역조직화학염색방법검측이식신조직활검표본C4d적표체.소유환자재행이식신천자진단위CAN후균급여료상규치료.결과 86례환자중,C4d침적양성자(C4d양성조)39례,C4d침적음성자(C4d음성조)47례,량조환자재성별、년령、공신래원、다차이식、이식시군체반응성항체수평등각지표적비교,차이균무통계학의의(P＞0.05).활검2년후,C4d양성조화음성조환자적SCr수평분별위(551.5±140.4)화(443.0±133.1)μmol/L,량조비교,차이유통계학의의(P＜0.05);병차C4d양성조환자이식신공능상실솔(23.1%,10/39)야현저고우C4d음성조(8.5%,4/47),량조비교,차이유통계학의의(P＜0.05).CAN치료전,C4d양성조발생고혈압화고혈지자다우음성조(P＜0.05);상규치료후,척제이식신공능상실자,량조간발생고혈압、고혈지、고혈당화고혈뇨산자차이무통계학의의(P＞0.05).결론 C4d양성적CAN환자제시유만성체액배척반응적삼여,림상상규치료예후교차,약침대체액면역반응진행간예,능구개선이식신장기존활.
Objective To investigate the effect of C4d deposition in peritubular capillary (PTC)in chronic allograft nephropathy (CAN) on prognosis and intervention of renal transplantation recipients. Methods All the cases who received the renal graft biopsy due to diagnosis of CAN from January 2000 to August 2008, and had the 2-year follow-up data were included in the study. The clinical data were analyzed according to the C4d deposition in PTC. Results Among 86 cases 39 cases were C4d positive (C4d+ group) and the remaining 47 cases were negative (C4d group). There was no significant difference in sex, age, donor source, transplant times, time after biopsy, the panel reactive antibodies (PRA) level between two groups (P＞0. 05). Before intervention, there was no significant difference in serum creatinine (Scr) and 24 h urinary protein between two groups (P＞0. 05). At the end of 2-year followed-up period, graft loss rate and urinary protein levels in C4d+group were significantly higher than in C4d- group (P＜0. 05). Before intervention, the incidence of blood lipid disorder and hypertension was higher in C4d- group (P ＜ 0. 05 ), but no significant difference was found in uric acid and blood sugar levels (P＞0. 05). At the end of 2-year followed-up period, there was no significant difference in blood glucose, uric acid, blood pressure and lipid profile (eliminating renal lost cases) between two groups (P＞0. 05). Conclusion The patients with CAN and C4d+ means the involvement of chronic humoral rejection and have poor clinical results. Effective intervention against humoral immune response can improve renal allograft survival.
