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目的探讨急性细胞性排斥伴肾小管周围毛细血管补体裂解片断(C4d)沉积对移植肾预后的影响。方法经病理证实的急性细胞性排斥肾移植患者145例,根据病理表现有否肾小管周围毛细血管C4d沉积,将其分为细胞性排斥+C4d阳性组(C4d阳性组)64例,单纯细胞性排斥组(C4d阴性组)81例。比较两组术前一般情况、排斥反应发病情况、抗排斥治疗、移植肾失功率及移植肾存活率。结果两组的术前一般情况比较差异无统计学意义(P>0.05)。C4d阳性组的急性细胞性排斥反应发生时间明显早于C4d阴性组,比较差异有统计学意义(P<0.05)。两组Banff分型Ⅰ型与Ⅱ型比例差异有统计学意义(P<0.01)。随访期间C4d阳性组有22例(34%)移植肾失功,明显高于C4d阴性组的11例(14%),比较差异有统计学意义(P<0.01)。Kaplan-Meier法分析发现C4d阳性组的移植肾存活率明显低于C4d阴性组(P<0.01),移植肾的5年生存率分别为51%、79%。结论急性细胞性排斥反应伴肾小管周围毛细血管C4d沉积的肾移植患者,术后较早发生排斥反应,抗排斥治疗效果较差,移植肾存活率低。
OBJECTIVE: To investigate the effect of acute cellular rejection on the prognosis of renal allograft with the deposition of peritubular capillary peritumoral lytic fragment (C4d). Methods 145 cases of pathologically confirmed acute rejection of renal allograft were divided into four groups according to the pathological findings: C4d deposition in C4d positive group (C4d positive group), simple cell Exclusion group (C4d negative group) 81 cases. The two groups were compared before the general situation, the incidence of rejection, anti-rejection therapy, graft failure and graft survival. Results There was no significant difference in preoperative general conditions between the two groups (P> 0.05). The acute rejection reaction of C4d positive group was earlier than that of C4d negative group, the difference was statistically significant (P <0.05). There was significant difference between the two groups in the type Ⅰ and type Ⅱ Banff classification (P <0.01). In the C4d positive group, 22 patients (34%) had graft failure in C4d positive group, which was significantly higher than that in C4d negative group (14%) (P <0.01). Kaplan-Meier analysis showed that the survival rate of grafted kidneys in C4d-positive group was significantly lower than that in C4d-negative group (P <0.01). The 5-year survival rates of grafted kidneys were 51% and 79%, respectively. CONCLUSIONS: Acute renal allograft rejection in acute renal transplant recipients with acute peripheral cellular reac- tions and peripheral C4d deposition of the capillaries results in earlier rejection. The anti-rejection therapy is less effective and the graft survival rate is lower.