中文摘要：

目的 研究同种异体肾移植术后急性排斥患者肾小球炎的细胞类型及其与管周毛细血管（PTC）C4d沉积的关系.方法 2006年6月至2009年6月在本中心行同种异体肾移植手术后,肾功能异常且病理证实为急性排斥并发小球炎受者51例的肾活检组织为研究对象.免疫组化方法检测同一活检标本连续切片内T细胞表面标记物CD3、巨噬细胞表面标记物CD68、体液性排斥特异性标记物C4d、细胞毒T淋巴细胞标记物颗粒酶B及调节性T淋巴细胞标记物Foxp3的表达情况.根据PTC有无C4d沉积将受者分为C4d阳性组和C4d阴性组,定量计数小球内阳性细胞数,并计算每个小球的平均细胞数.结果 C4d阳性与C4d阴性的急性排斥受者小球内浸润的炎细胞数分别为17.79±7.70和8.17±3.80,差异有统计学意义（P＜0.01）.C4d阳性急性排斥受者小球内以巨噬细胞浸润为主,与C4d阴性者差异有统计学意义（13.73±7.03比2.57±1.22,P＜0.01）.C4d阴性急性排斥受者小球内以T淋巴细胞为主,与C4d阳性者差异有统计学意义（5.60±2.81比4.05±2.60,P=0.023）.C4d阴性与C4d阳性急性排斥受者小球内T淋巴细胞都以细胞毒细胞为主（3.37±2.34比4.27±2.41,P=0.141）,而没有调节性T淋巴细胞的浸润.结论 肾移植术后急性排斥患者小球内炎细胞浸润总数与PTC的C4d沉积有关.C4d阳性患者小球炎细胞数多于C4d阴性患者.C4d阳性患者小球炎细胞以巨噬细胞浸润为主;C4d阴性患者小球炎细胞以T淋巴细胞浸润为主.两组患者小球内T淋巴细胞都以细胞毒细胞为主.

英文摘要：

Objective To investigate the cell types of renal allograft glomerulitis in posttransplantation patients and its relationship with peritubular capillary （PTC） C4d deposition.Methods Fifty-one allograft kidney transplant recipients diagnosed as acute rejection from June 2006 to June 2009 in our center were enrolled in this retrospective study. Fifty-one biopsy specimens of these patients accompanied with glomerulitis were examined by immunostain for macrophages, T cells, granzyme B, Foxp3 and C4d. Glomeular macrophages, T cells, cytotoxic T cells, regulatory T cells were counted. The recipients were divided into C4d＋ and C4d- groups according to the C4d deposition in peritubular capillaries. Results The total number of glomerular infiltrating cells in C4d＋ group was significantly higher than that in C4d- group （17.79±7.70 vs 8.17±3.80, P〈0.01）. The infiltrating cell was predominantly macrophage in CAd＋ group and significantly higher as compared to C4d- group （13.73 ±7.03 vs 2.57 ±1.22, P〈0.01）.However, the infiltrating cell was predominantly T cell in C4d- group and significantly higher as compared to C4d＋ group （5.60±2.81 vs 4.05±2.60, P=0.023）. The infiltrating T cells in both groups were predominantly cytotoxic T cells. Conclusions The total number of infiltrating cells in glomerulitis is related to peritubular capillary C4d deposition. The infiltrating cell is predominantly macrophage in C4d＋ group and predominantly T cell in C4d- group. Meanwhile the infiltrating T cell in both groups is predominantly cytotoxic T cell.