课题背景：了解细胞性排斥、体液性排斥机制并诱导免疫耐受，降低或避免移植排斥的发生是目前移植免疫学家的主要工作重点。近年来对于体液排斥反应机制的研究逐步深入，肾小管周毛细血管C4d的阳性沉积已作为体液排斥反应的重要诊断标准之一。但由于补体具有的多种活化途径导致了C4d仍旧不能作为诊断体液排斥反应的金标准。然而，体液排斥反应由浆细胞分泌抗体激活补体介导产生，所以对于移植肾中浸润的浆细胞群是否分泌了抗体参与体液排斥，并是否导致预后较差是文章的研究重点。

应用要点：文章结果提示，浆细胞群在移植肾中的浸润与移植肾长期存活关系密切，新型抗CD20单克隆抗体美罗华已经成功地应用于多种B细胞性疾病如多发性骨髓瘤等。临床上若在难治性排斥反应移植肾组织活检中显示CD138浆细胞群聚性浸润，是否可通过应用美罗华阻止CD20 B细胞转化为浆细胞，从而提高移植肾的长期存活，值得进一步研究。

同行评价：文章通过检测切除移植肾组织中CD138的表达，分析浆细胞在移植肾组织中聚集性浸润与移植肾存活时间的相关性。立意较新，有一定的临床意义。

摘要
目的: CD138是浆细胞表面特有的细胞标记，移植肾中浸润的浆细胞群是否分泌抗体参与体液排斥反应导致移植肾预后效果不佳？检测切除移植肾组织中CD138的表达，分析浆细胞在移植肾组织中聚集性浸润与移植肾存活时间的关系。
方法：选择1989-06/2006-12解放军总医院第二附属医院全军器官移植中心收治的因难治性排斥致移植肾切除患者40例作为移植肾切除组，移植术后因移植肾功能异常行常规穿刺活检患者20例为对照组，所有患者对治疗及实验方案均知情同意，且得到医院伦理道德委员会批准。应用CD138多克隆抗体对肾组织标本石蜡切片行免疫组织化学染色，检测CD138在两组中的表达情况；同时记录移植肾切除组患者移植肾的存活时间，分析CD138的表达与移植肾存活时间的关系。
结果：①移植肾切除组的移植肾组织中CD138阳性23例，占57.5%；对照组穿刺移植肾标本中CD138阳性3例，占15.0%，两组CD138阳性率差异存在显著性意义（P= 0.004 3）。②移植肾切除组中CD138阳性患者的移植肾存活时间低于CD138阴性患者（P= 0.033 8）。
结论：浆细胞在移植肾组织中聚集性浸润是影响移植物长期存活的危险因素。
关键词：肾移植；移植物排斥；抗原，CD；浆细胞

许亮，石炳毅，许晓光，韩永，王强，周文强，蔡明.浆细胞聚集性浸润在移植肾丢失中的作用：40例切除移植肾标本中CD138的表达[J].中国组织工程研究与临床康复，2008，12(5):849-852
[www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-849(ps).pdf]

Role of plasma nodule infiltration in renal graft loss: Expression of CD138 in excised renal allograft in 40 cases

Abstract

AIM：CD138 is a specific surface marker of plasmocyte, does the plasma nodules infiltrated in the renal grafts secrete antibody to participate in the rejection reaction of body fluid and result in the poor prognosis? This study was to analyze the expression of CD138 in renal allograft, and explore the correlation between the plasma nodules infiltration and the graft survival.
METHODS: From June 1989 to December 2006, 40 patients underwent allograft excision due to incurable rejection as excised group, and 20 patients with renal function temporary abnormality received routine puncture biopsy as control group were admitted to the Organ Transplantation Center in the Second Affiliated Hospital of Chinese PLA General Hospital, and were all enrolled in this study. Informed consents were obtained from all the patients, and the experiment was approved by the hospital ethical committee. CD138 polyclonal antibody was used to conduct immunohistochemistry in paraffin section of excised renal tissues, and then detect the expression of CD138. Meanwhile, the long-term graft survival of the excised group patients was recorded, and the correlation between CD138 expression and graft survival was studied.
RESULTS: ①There were 23 specimens positive for CD138 in the excised group, accounting for 57.5%; 3 specimens (15.0%) in the control group were positive for CD138. CD138-positive expression rate exhibited a significant difference between two groups (P=0.004 3).②In the excised group, the graft survival in patients with CD138-positive expression was lower than that in the patients with CD138-negative expression (P=0.033 8).
CONCLUSION: Plasma nodules infiltration in renal allograft is a risk factor for the long-term graft survival.

Xu L, Shi BY, Xu XG, Han Y, Wang Q, Zhou WQ, Cai M.Role of plasma nodule infiltration in renal graft loss: Expression of CD138 in excised renal allograft in 40 cases.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):849-852(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-849(ps).pdf]