急性移植肾排斥反应类固醇冲击治疗后淋巴细胞凋亡作用.doc

急性移植肾排斥反应类固醇冲击治疗后淋巴细胞凋亡作用 　 ; 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:; 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