| | | 急性移植肾排斥反应类固醇冲击治疗后淋巴细胞凋亡的作用
| | 预防医学论文 作者：张波 王禾 张绍增 武国军 李欣 杨晓剑 于磊 张更
【关键词】 肾移植
Study on apoptosis of tubular epithelial cells and lymphocyte in acute rejection of renal allograft after steroid pulse therapy
【Abstract】 AIM: To explore the changes of apoptosis of tubular epithelial cells and lymphocyte in acute rejection of renal allograft after steroid pulse therapy. METHODS: Renal biopsy specimens of 64 transplant recipients with acute rejection were examined for apoptosis. Biopsies were performed after steroid pulse therapy and were compared with 40 transplant biopsies with unspecific organ injury of lymphocyte infiltration. Apoptosis cells of grafts were monitored by terminal deoxynucleotidyltransferasemediated dUTPdigoxigenin nick end labeling (TUNEL) analysis. RESULTS: The TUNEL showed that in the 64 cases of the acute rejection group, apoptosis of lymphocytes was found in 44 cases, that of tubular epithelial cells in 34 cases and no apoptosis in 20 cases. In the 40 cases of the control group, 24 biopsies showed tubular epithelial apoptosis (P＝0.2351) and 4 cases showed lymphocyte apoptosis (P＝0.000). According to the Banff classification, 16 cases were gradeⅠof acute rejection, 34 grade Ⅱand 14 grade Ⅲ. lymphocyte apoptosis were found in 14 cases, 22cases and 8 cases, respectively (P=0.1530). CONCLUSION: In the acute rejection of renal allograft after steroid pulse therapy, lymphocyte apoptosis is a phenomenon predominantly restricted to rejection processes, which may be related to the prognosis of acute rejection.
【Keywords】 renal transplantation; acute rejection；apoptosis
【摘要】 目的预防医学论文: 探讨在初始类固醇冲击治疗后急性肾移植排斥反应中浸润淋巴细胞的预防医学论文凋亡情况. 方法: 64例发生急性细胞性排斥反应的患者的肾活检标本，活检均于类固醇冲击治疗后3 d进行. 检测活检标本的细胞凋亡并与40例有淋巴细胞浸润的非特异肾损伤标本进行比较. 采用原位末端标记法（TUNEL）检测细胞凋亡. 结果: 在急性排斥组（n=64）中有44例患者标本中观察到淋巴细胞凋亡，34例中观察到肾小管上皮细胞凋亡，20例中未检测到细胞凋亡. 对照组（n=40）中有24例检测到肾小管上皮细胞凋亡(P＝0.2351)，淋巴细胞凋亡在4例患者中发现(P＝0.000). 根据Banff分类Ⅰ级排斥反应为16例，Ⅱ级为34例，Ⅲ级为14例，检测到淋巴细胞凋亡分别为：14例，22例和8例(P=0.1530). 结论: 在初始类固醇冲击治疗后急性肾移植排斥反应中浸润淋巴细胞凋亡是重要的，可能与排斥反应的转归有关.
【关键词】 肾移植；急性排斥反应；凋亡
0引言
为了探讨同种异体肾移植急性排斥反应(acute rejection, AR)类固醇冲击治疗后细胞凋亡的变化，我们采用原位末端标记法（TUNEL）对患者的移植肾穿刺活检标本中肾小管上皮细胞及浸润淋巴细胞凋亡进行了检测.
1对象和方法
1.1对象试验组为接受尸体肾移植64（男42，女22）例患者，平均年龄34岁. 供者年龄平均26岁. 供受者ABO血型相同，淋巴细胞毒交叉配合试验小于0.10，群体反应抗体（PRA）阴性. 移植后常规采用环孢素A+霉酚酸酯+泼尼松治疗. 急性排斥反应发生于移植后1～6 mo. 急性排斥反应发生前血Cr为(118±17) μmol・L-1，发生中为(411±192) μmol・L-1. 发生急性排斥后连续3 d用甲基强地松龙（第1日500 mg，第2，3日分别为250 mg）冲击治疗. 在冲击治疗后第3日于B超或CT介导下用Menghini或Trucut穿刺针进行移植肾穿刺活检. 对照组选取有淋巴细胞浸润的非排斥反应的移植肾活检标本40(男26，女14)例，平均年龄35岁.
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