移植肾内新生淋巴管检测临床意义.docVIP

移植肾内新生淋巴管检测临床意义 　 作者：吴卫真　陈忠华　朱凌峰　王栋　叶永峰　谭建明 【摘要】 　　目的： 探讨移植肾微淋巴管检测在排斥反应的诊断和移植肾病理分型上的临床意义. 方法： 对77例肾移植患者的134份移植肾组织标本，用Podoplanin单抗二步法免疫组化标记移植肾内淋巴管，计算移植肾内淋巴管密度(LVD)，根据不同的病理诊断进行对比分析. 结果： 肾功能稳定的移植肾组织LVD平均值最低，为1.03±0.31，与其他各组的两两比较均有统计学差异(Plt;0.05). 慢性/硬化性移植肾肾病组LVD平均值最高，为18.35±4.79，与其他各组间的两两比较均有统计学差异(Plt;0.01). 急性细胞性排斥反应与C4d+急性排斥反应比较无统计学差异(Pgt;0.05). 结论： 检测移植肾内淋巴管增生有助于移植肾排斥反应的临床诊断和预后判断，并指导抗排斥治疗. 移植肾淋巴管生成可能参与慢性排斥反应的发生和发展. 【关键词】 肾移植；淋巴管生成；移植物排斥 　　Clinical implication of monitoring lymphatic neoangiogenesis in renal transplants 　【Abstract】 AIM: To investigate the clinical implication of monitoring lymphatic neoangiogenesis in rejection diagnosis and pathological typing. METHODS: To identify the lymphatic neoangiogenesis, 134 biopsy specimens from 77 patients were performed on with immunohistochemical staining for antipodoplanin monoclonal antibody. The lymphatic vessel density (LVD) was calculated and then compared among different specimens according to clinical diagnosis and posttransplantation duration. RESULTS: The lowest mean LVD (1.03±0.31) was observed in the specimens from transplants with normal function, which differed significantly from other groups (Plt;0.05). Compared with other groups, significantly higher mean LVD (18.35±4.79) was recorded in the specimens from transplants with chronic rejection (Plt;0.01). No significant difference in mean LVD was observed between the specimens with acute cellular rejection and C4d positive acute rejection (Pgt;0.05). CONCLUSION: Monitoring the lymphatic neoangiogenesis is helpful for the clinical diagnosis of rejection and the evaluation of renal transplant prognosis. The lymphatic neoangiogenesis in renal transplants may be involved in the occurrence and development of chronic rejection. 　　【Keywords】 kidney transplantation; lymphangiogenesis; grafl rejection 　　0引言 　　淋巴管生成(lymphangiogenesis）参与体内许多生理和病理过程,如胚胎发育、伤口愈合、组织和器官再生、肿瘤生长和转移等. 淋巴系统又是重要的免疫器官，它既是免疫细胞的运输通道又在调节免疫细胞组织浸润中起重要作用. 有关移植肾内淋巴管生成的研究较少，国内尚未见有类似研究报道. 本研究采用淋巴管上皮细胞特