CAJ | 학술논문

目的研究心脏移植术后移植心中抗体介导的排斥反应(AMR)的发生情况及其组织病理学特征.方法 2003年1月至2007年12月接受心脏移植的受者10例.术后受者移植心功能异常时,以及术后1个月、3个月、1年、2年和3年时进行移植心心内膜心肌活检(EMB),共取得17份活检组织样本,进行常规病理学和C4d免疫组织化学染色.依据2004年国际心脏和肺移植学会(ISHLT)的病理学诊断体系以及移植心AMR诊断体系进行病理学诊断.C4d免疫组织化学染色结果以0至+++予以分级.结果 10例17次EMB中,1次样本不合格,余16次EMB中,7例次诊断为C4d阳性AMR,3例4次诊断为急性细胞性排斥反应,2例次诊断为Quilty损伤.7例次AMR中,1例合并急性细胞性排斥反应,余6例次均为单独发生.10例受者中,1例移植后20个月死亡,尸体解剖检查诊断为慢性排斥反应合并AMR和急性细胞性排斥反应(ISHLT分级3级).其移植心AMR组织学特征为局灶性至广泛性心肌间毛细血管内皮C4d阳性沉积.结论 AMR是心脏移植术后主要的并发症之一,EMB及其C4d免疫组织化学染色是早期诊断AMR的有效方法.
목적 연구심장이식술후이식심중항체개도적배척반응(AMR)적발생정황급기조직병이학특정.방법 2003년1월지2007년12월접수심장이식적수자10례.술후수자이식심공능이상시,이급술후1개월、3개월、1년、2년화3년시진행이식심심내막심기활검(EMB),공취득17빈활검조직양본,진행상규병이학화C4d면역조직화학염색.의거2004년국제심장화폐이식학회(ISHLT)적병이학진단체계이급이식심AMR진단체계진행병이학진단.C4d면역조직화학염색결과이0지+++여이분급.결과 10례17차EMB중,1차양본불합격,여16차EMB중,7례차진단위C4d양성AMR,3례4차진단위급성세포성배척반응,2례차진단위Quilty손상.7례차AMR중,1례합병급성세포성배척반응,여6례차균위단독발생.10례수자중,1례이식후20개월사망,시체해부검사진단위만성배척반응합병AMR화급성세포성배척반응(ISHLT분급3급).기이식심AMR조직학특정위국조성지엄범성심기간모세혈관내피C4d양성침적.결론 AMR시심장이식술후주요적병발증지일,EMB급기C4d면역조직화학염색시조기진단AMR적유효방법.
Objective To observe the pathologic features on cardiac allograft and to test archived endomyocardial biopsy specimens for antibody-mediated rejection specific marker-C4d deposition and its characteristics by using immunoperoxidase (IP) techniques. Methods From January 2003 to December 2007,10 recipients underwent orthotopic cardiac transplantation and 17 specimens of endomyocardial biopsy were obtained either for a protocol basis (generally at 1 st month,3rd month,1st year and 2nd year post-transplant) and on immediate clinical indications.All specimens of endomyocardial biopsy were collected for histopathological examination and C4d immunohistochemical staining,simultaneously. All pathological diagnoses were done according to 2004 International Society for Heart and Lung Transplantation (ISHLT) recommendation working formulation and AMR Schema,and C4d staining intensity were graded and recorded as 0 to 3 +.Results Except 1 specimen unqualified,all 16 consecutive specimens of endomyocardial biopsy were qualified.There were 4 cases of acute T cell-mediated rejection (all graded 1 ),2 cases of Quilty lesion,and 7 cases of antibody-mediated rejection,who were documented according to ISHLT Schema and C4d deposition.Meanwhile,there were 6 cases showing evidence of antibody-mediated rejection without concurrent acute cellular rejection and only one case concordant with acute T cell-mediated rejection.One case of antibody-mediated rejection died 20 months posttransplantation due to combined transplant coronary artery disease (TCAD). The C4d in the cardiac allograft was deposited in microvasculature diffusively.Conclusion Antibody-mediated rejection is an important clinical entity following orthotopic heart transplantation and is difficult to diagnosis except to perform endomyoeardial biopsy.Immunoperoxidase staining for C4d is a sensitive and specific technique for detecting one marker of antibody-mediated rejection.