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摘要: 抗体介导的排斥反应（AMR）亦称体液性排斥反应，是由抗体、补体等多种体液免疫效应因子参与所致的排斥反应免疫损伤。AMR在超急性排斥反应、急性排斥反应以及慢性排斥反应中均发挥了重要的致病作用。本文对AMR的基本定义、Banff移植病理学诊断标准（Banff标准）中AMR病理学的研究历程及其主要成果以及移植肾AMR的主要病变特征进行综述，旨在为准确诊断、及时治疗AMR提供依据，以保障移植肾和受者的长期存活。
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关键词:
- 抗体介导的排斥反应（AMR） /
- 供者特异性抗体（DSA） /
- 抗体依赖细胞介导的细胞毒作用（ADCC） /
- T细胞介导的排斥反应（TCMR） /
- Banff移植病理学诊断标准（Banff标准） /
- C4d /
- 血栓性微血管病 /
- 慢性移植物血管病
Abstract: Antibody-mediated rejection (AMR), also known as humoral rejection, is an immune injury caused by rejection involved with multiple humoral immune effectors, such as antibodies and complements, etc. AMR plays a pivotal role in hyperacute, acute and chronic rejection. In this article, the basic definition of AMR, the research progress and major achievements on AMR pathology according to Banff classification on allograft pathology (Banff classification), and main pathological characteristics of AMR in renal allograft were reviewed, aiming to provide reference for accurate diagnosis and timely treatment of AMR, and guarantee the long-term survival of renal graft and recipients.-
Key words:
- Antibody-mediated rejection (AMR) /
- Donor specific antibody (DSA) /
- Antibody-dependent cell-mediated cytotoxicity (ADCC) /
- T cell-mediated rejection (TCMR) /
- Banff classification on allograft pathology (Banff classification) /
- C4d /
- Thrombotic microangiopathy /
- Chronic allograft vasculopathy
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图 1 移植肾aAMR的C4d免疫组化染色表现
注：A图示移植肾组织C4d免疫荧光染色呈弥漫性肾小管周毛细血管内皮细胞阳性（×200）；B图示移植肾组织C4d免疫酶组化染色呈阳性（箭头所示）（×400）。
Figure 1. C4d immunohistochemical staining findings of aAMR in renal allograft
图 2 移植肾aAMR的肾小球炎病理学表现
注：图示肾小球毛细血管袢腔内中性粒细胞等炎症细胞浸润。A图为Masson三色染色（×200）；B图为HE染色（×400）；C图中电镜下可见肾小球毛细血管袢腔内多个淋巴细胞淤积（箭头所示）（×6 000）。
Figure 2. Pathological findings of glomerulitis of aAMR in renal allograft
图 3 移植肾aAMR的肾小管周毛细血管炎病理学表现
注：A图示肾小管周毛细血管的管腔扩张，管腔内有多个炎症细胞淤积、浸润（箭头所示）（PAS，×200）；B图示肾小管周毛细血管内淋巴细胞（红色箭头所示）和中性粒细胞（黑色箭头所示）淤积浸润（HE，×1 000）；C图示肾小管周毛细血管内皮细胞（箭头所示）C4d免疫酶组化染色阳性，管腔内炎症细胞淤积、浸润（星号所示）（×200）。
Figure 3. Pathological findings of peritubular capillaritis of aAMR in renal allograft
图 4 移植肾aAMR的动脉内膜炎病理学表现
注：A图示动脉内皮上少量淋巴细胞浸润，局部内膜轻度水肿（箭头所示）（HE，×200）；B图示动脉内膜炎，动脉内膜明显水肿、增厚导致管腔狭窄，水肿增厚的内膜内可见淋巴细胞浸润（箭头所示）（HE，×400）；C图示移植肾内动脉管壁纤维素样坏死（箭头所示）（HE，×400）。
Figure 4. Pathological findings of endarteritis of aAMR in renal allograft
图 5 移植肾aAMR的TMA病理学表现
注：图示肾小球毛细血管内皮细胞肿胀伴炎症细胞浸润，毛细血管内皮细胞下间隙增宽，部分毛细血管腔内微血栓栓塞（磷钨酸苏木素，×1 000）。
Figure 5. Pathological findings of TMA of aAMR in renal allograft
图 6 移植肾caAMR的慢性TG病理学表现
注：A图示弥漫性肾小球基底膜增厚及局灶性双轨征形成（箭头所示），肾小球内无嗜复红蛋白沉积（PASM，×200）；B图示肾小球毛细血管基底膜增厚（星号所示）和双轨征形成（箭头所示）（Masson，×1 000）；C图电镜下可见增生的系膜基质插入基底膜致毛细血管基底膜增厚呈双轨征（箭头所示）（×5 000）。
Figure 6. Pathological findings of chronic TG of caAMR in renal allograft
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