Bonnaud E N, Lewis N P, Masek M A, Billingham M E
Department of Cardiology and Pathology, University of Bordeaux, France.
J Heart Lung Transplant. 1995 Jan-Feb;14(1 Pt 1):163-71.
To study the reliability and usefulness of immunofluorescence on heart biopsy specimens for routine monitoring of heart transplant recipients for rejection, frozen sections of 72 consecutive endomyocardial biopsy specimens from 18 heart transplant recipients during the first 6 weeks after transplantation (and later) and from 11 control specimens from donor hearts and other nontransplantation patients were studied. Fifteen patients received OKT3 induction. The diagnosis of vascular (humoral) rejection pattern as defined by Hammond was based on the microvascular deposition of immunoglobulin and C3 or C1q. Echocardiographic data and right-sided heart catheterization were obtained simultaneously.
The results showed that immunofluorescence was positive for a vascular rejection pattern in 60% (43 of 72) overall, in heart transplant recipients it was positive in 59% (36 of 61), and in control subjects it was positive in 63% (7 of 11). Most of the patients who had positive immunofluorescence had no hemodynamic compromise. Humoral rejection was not predicted by positive immunofluorescence in our study. We also found no correlation with either positive or negative immunofluorescence for the short-term or long-term outcome during the first 6 weeks after transplantation.
The usefulness of routine immunofluorescence in all surveillance heart biopsies is questionable as determined by this study.
为研究免疫荧光技术用于心脏移植受者排斥反应常规监测时在心脏活检标本上的可靠性及实用性，我们对18例心脏移植受者在移植后（及之后）前6周内连续获取的72份心内膜活检标本的冰冻切片，以及11份来自供体心脏和其他非移植患者的对照标本进行了研究。15例患者接受了OKT3诱导治疗。根据哈蒙德所定义的血管（体液）排斥反应模式的诊断基于免疫球蛋白和C3或C1q在微血管的沉积情况。同时获取了超声心动图数据和右侧心导管检查数据。
结果显示，总体上60%（72例中的43例）的血管排斥反应模式免疫荧光呈阳性，心脏移植受者中59%（61例中的36例）呈阳性，对照受试者中63%（11例中的7例）呈阳性。大多数免疫荧光呈阳性的患者并无血流动力学损害。在我们的研究中，免疫荧光阳性并不能预测体液排斥反应。我们还发现，移植后前6周内的短期或长期预后与免疫荧光阳性或阴性均无相关性。
本研究表明，常规免疫荧光技术在所有监测性心脏活检中的实用性值得怀疑。
