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

doi:10.6040/j.issn.1671-7554.0.2016.1307

摘要/Abstract

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。

关键词: 肾脏移植, 淋巴细胞, 非供者特异性抗体, 供者特异性抗体, 免疫状态监测

Abstract: Objective To analyze and monitor lymphocytes ratio, donor specificity antibodies(DSA)and non-donor specificity antibodies(NDSA)levels for acute rejection(AR)diagnosis on the early stage of kidney transplantation. To provide reliable basis for clinical prevention of rejection reaction, early diagnosis of rejection, formulate reasonable individualized immunosuppressive therapy and evaluate therapeutic effect. Methods A total of 454 patients who accepted kidney transplantation in our department from January 2014 to June 2016 were enrolled in this study. Recipients lymphocytes ratio, DSA, and NDSA were monitored with flow cytometry and Luminex. Data were analyzed statistically by SPSS17.0 software. Results Within 6 months after transplantation, 33 cases(7.3%)occurred AR(AR group)and 421 cases had stable allograft function(SF group). The CD4⁺T/CD8⁺T ratio(2.81±0.85 vs 1.39±0.94, t=7.336, P<0.001)and B cell percentage［(15.79±3.53)% vs(10.2±3.04)%, t=4.986, P<0.001］ were significantly higher in the AR group than the SF group. The HLA antibody medium fluorescent intensity(MFI)of the AR group was gradually increased one week after transplantation and had an obviously difference with that of the SF 山东大学学报 (医学版)55卷7期 -郑瑾,等.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 \=-group(P<0.05). The average value of MFI was 7 559±1 496 in the AR group and it was decreased statistically after treatment(5 023±996)(t=13.853, P<0.001). AR occurrence was 3.1%(11/357)and 14.5%(12/83)in DSA-/NDSA- and DSA-/NDSA+ recipients, respectively. For DSA+/NDSA+ recipients, AR occurrence was 71.4%(10/14)which was significantly higher than DSA-/NDSA- and DSA-/NDSA+ recipients(P<0.001). Conclusion Monitoring CD4⁺T/CD8⁺T ratio, B lymphocyte percentage and serum DSA/NDSA levels could assist in the diagnosis and the early warning of AR.

Key words: Lymphocyte, Non-donor specificity antibodies, Renal transplant, Immune state monitoring, Donor specificity antibodies

中图分类号:

R392.4

郑瑾,张江伟,王旭珍,匡陪丹,何晓丽,薛武军. 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[J]. 山东大学学报（医学版）, 2017, 55(7): 89-94.

ZHENG Jin, ZHANG Jiangwei, WANG Xuzhen, KUANG Peidan, HE Xiaoli, XUE Wujun. Significance of lymphocytes and DSA monitoring for acute rejection diagnosis on the early stage of kidney transplantation[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 89-94.

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