供者特异性、分泌γ干扰素的细胞的频数与术后半年及一年时移植肾功能的关系  

The frequency of donor-specific,IFN-γ-producing lymphocyte correlates with the risk of posttransplant rejection episodes and graft function at 6 and 12 months in renal-transplant recipients

作　　者：孙雯[1] 陈忠华 毕如玫[1] 张玉海[1] 徐秀红[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050 [2]华中科技大学同济医学院器官移植研究所

出　　处：《中华器官移植杂志》2006年第11期678-680,共3页Chinese Journal of Organ Transplantation

基　　金：基金项目:国家"973"重大基础研究项目资助(2003CB515505)

摘　　要：目的探讨肾移植患者体内供者特异性、分泌γ干扰素(INF-γ)的细胞的频数(以下简称“供者特异性细胞频数”)与急性排斥反应和移植肾功能的关系。方法分别于肾移植前及术后1、2、3、4、6、8、12、16、20和24周时采集患者(48例)的外周血,分离出淋巴细胞,以酶联免疫斑点实验(ELISPOT)检测供者特异性细胞频数,测定术后6个月和12个月时血肌酐和肾小球滤过率。结果41例术后未发生急性排斥反应者,其术前供者特异性细胞频数小于150/500000,7例术后发生急性排斥反应．3例(42．9%)术前供者特异性细胞频数超过150/500000。术后第2、3周时的供者特异性细胞频数与术后半年和1年时的血肌肝水平呈显著正相关,而与术后半年和1年时的肾小球滤过率呈显著负相关(P＜0．05)；术后第6个月时供者特异性细胞频数与血肌肝水平(术后第6个月及第12个月)具有相关性,但不具有统计学意义。结论术前测定供者特异性细胞频数可以为判断受者对供者特异性免疫反应能力提供一定依据；术后早期监测患者体内供者特异性细胞频数可以预测患者发生亚临床型排斥反应所导致的移植物损伤的危险性。Objective To investigate the possibility of whether the frequency of donor-specific, IFN-γ-producing lymphocyte could correlate with the risk of posttransplant rejection episodes and graft function at 6 and 12 months in renal-transplant recipients. Methods Frequencies of interferin-γ- producing donor-reactive cells were serially determined in unselected renal transplant patients by using enzyme-linked immunosorbent spot assay （ELISPOT） before transplantation and 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 weeks posttransplantation （n = 48） to study detailed kinetics and analyze the correlation with acute rejection and graft function at 6 and 12 months posttransplantation. Results Among 48 recipients, 41 recipients with donor-specific responses of 〈150/500000 PBLs before transplantation have not had a rejection episode, while the other 3 recipients developed acute rejection with the frequency of donor-specific responses were over 150/500000 PBLs, respectively （42.9%）. Mean frequencies of donor-specific, IFN-γ-producing lymphocyte at week 2 and 3 post transplant showed a statistically significantly positive correlation with serum creatinine at 6 and 12 months and a significantly negative correlation with GFR 6 and 12 months in renal transplant recipients （P〈0.05）. Frequencies of donor-specific, IFN-γ-producing lymphocyte at week 12 post-transplant showed a positive correlation with serum creatinine 6 and 12 months, but without statistical significance. Conclusion The determination of frequency of donor-specific, IFN-γ-producing lymphocyte pre-transplantation may provide useful informations to define the strength of allospecific immune response to the specific donor. Monitoring the frequency of donor-specific, IFN-γ-producing lymphocyte during the earlier period post-transplantation might identify patients at risk for ongoing immune-mediated graft damage due to subclinical rejection.

关 键 词：肾移植 免疫测定 干扰素Ⅱ型 淋巴细胞 移植物 肾功能试验 

分 类 号：R699.2[医药卫生—泌尿科学]