山东大学学报(医学版) ›› 2017, Vol. 55 ›› Issue (7): 89-94.doi: 10.6040/j.issn.1671-7554.0.2016.1307
郑瑾,张江伟,王旭珍,匡陪丹,何晓丽,薛武军
ZHENG Jin, ZHANG Jiangwei, WANG Xuzhen, KUANG Peidan, HE Xiaoli, XUE Wujun
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, P<0.001)及B细胞百分比[(15.79±3.53)% vs(10.2±3.04)%, t=4.986, P<0.001]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(P<0.05)。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, P<0.001)。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(P<0.001)。 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。
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