肾移植术后早期淋巴细胞及DSA监测在诊断移植排斥反应中的意义

发布时间：2018-05-05 17:13

本文选题：肾脏移植 + 免疫状态监测　；参考：《山东大学学报(医学版)》2017年07期

【摘要】：目的分析并监测肾移植术后早期急性排斥反应(AR)患者淋巴细胞亚群比例,供者特异性抗体(DSA)及非供者特异性抗体(NDSA)水平,为临床预防排斥反应的发生、早期诊断排斥反应,以及制定合理的个体化免疫抑制治疗方案、评估治疗效果提供可靠依据。方法选择2014年1月至2016年6月肾脏移植受者454例,采用流式细胞计术及Luminex技术对肾脏移植受者术后淋巴细胞比例、DSA及NDSA进行动态监测,应用SPSS 17.0软件进行统计学分析。结果 454例受者中,33例术后6个月内发生AR(AR组),421例肾功能稳定(SF组)。肾脏移植受者AR发生时,外周血CD4+T/CD8+T比值(2.81±0.85 vs 1.39±0.94,t=7.336,P0.001)及B细胞百分比[(15.79±3.53)%vs(10.2±3.04)%,t=4.986,P0.001]显著高于SF组。HLA抗体中位荧光强度(MFI)的监测发现,AR患者在移植术后1周左右HLA抗体水平逐渐升高,与SF组MFI相比,差异有统计学意义(P0.05)。AR患者排斥反应发生时抗体MFI值为7 559±1 496,治疗后为3 023±996,差异有统计学意义(t=13.853,P0.001)。DSA-/NDSA-患者AR发生率为3.1%(11/357);DSA-/NDSA+患者AR发生率为14.5%(12/83);DSA+/NDSA+患者AR发生率为71.4%(10/14),与前两者相比差异有统计学意义(P0.001)。结论肾脏移植术后早期监测CD4+T/CD8+T比值及B淋巴细胞百分比的变化及血清DSA/NDSA水平对于AR诊断和预警具有一定的指导价值。
[Abstract]:Objective to analyze and monitor the percentage of lymphocyte subsets, donor-specific antibodies (DSAs) and non-donor-specific antibodies (NDSAs) in early acute rejection (ARR) patients after renal transplantation, so as to prevent the occurrence of rejection and to diagnose rejection in the early stage. The rational individualized immunosuppressive therapy was established to provide reliable basis for evaluating the therapeutic effect. Methods from January 2014 to June 2016, 454 renal transplant recipients were studied. Flow cytometry and Luminex techniques were used to dynamically monitor the lymphocyte ratio and NDSA after renal transplantation. SPSS 17.0 software was used for statistical analysis. Results among the 454 recipients, 33 cases developed AR(AR within 6 months after operation. 421 cases of renal function stability were found in SF group. The ratio of CD4 T/CD8 T to peripheral blood CD4 T/CD8 T was 2.81 卤0.85 vs 1.39 卤0.94t ~ 7.336g / P 0.001) and the percentage of B cells [15.79 卤3.53)%vs(10.2 卤3.04] was significantly higher than that of SF group. The level of HLA antibody in AR patients was higher than that in SF group about 1 week after transplantation. Compared with SF group MFI, There was a significant difference in the MFI value of antibody MFI at the onset of rejection in patients with P0.055.AR and 3 023 卤996 after treatment. There was a statistically significant difference in the incidence of AR between the patients with DSA-P 0.001N. DSA-r NDSA-11 / 357DSA-r NDSA with AR of 14.5g / 1283DSA / NDSA, 71.4 / 1014a with the former two groups, the incidence of AR in the patients with DSA-R / R NDSA was 14.559 卤1.496, and the incidence of AR was 71.4 / 1014in the patients with DSA-r / NDSA-NDSA / DSA-r / NDSA-R, respectively. The difference was statistically significant (P 0.001). Conclusion the early monitoring of CD4 T/CD8 T ratio, B lymphocyte percentage and serum DSA/NDSA level after renal transplantation is valuable for the diagnosis and early warning of AR.
【作者单位】：西安交通大学第一附属医院肾病医院肾移植科;
【基金】：国家自然科学基金面上项目(81670682) 陕西省自然科学基础研究计划(2015JM8392)
【分类号】：R699.2

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