同种异体手移植术后患者的早期免疫学状态(英文)  

Early immunologic status of patients following hand allotransplantation

作　　者：郑小飞[1] 尹庆水[1] 吴文[1] 裘宇蓉[2] 裴国献[3] 

机构地区：[1]解放军广州军区广州总医院骨科,广东省广州市510010 [2]解放军第一军医大学附属南方医院检验科,广东省广州市510515 [3]解放军第一军医大学附属南方医院创伤骨科,广东省广州市510515

出　　处：《中国临床康复》2006年第45期203-205,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:同种异体肢体移植在动物实验中已有大量免疫学方面的研究,但由于临床只是早期的探索,对其临床免疫学研究需要进一步积累。目的:动态分析异体手移植患者术后早期免疫学状态的变化。设计:对照实验。单位:解放军广州军区广州总医院骨科,解放军第一军医大学南方医院创伤骨科和检验科。对象:实验组纳入解放军广州军区广州总医院骨科两例单侧异体手移植的患者,观察时间1999-09/2000-03。健康对照组为同期本院体检者20人,男12人,女8人,年龄20～45岁,均为自愿者,无活动性免疫性和感染性疾病。方法:2例手移植患者手术前1和3d各采外周血1次,术后第1周采血1次/d,2～4周采血3次/周,5～8周采血2次/周,9～16周采血1次/周,5～6个月采血2次/月。①运用流式细胞仪检测外周血T细胞亚群(CD3+,CD4+,CD8+T细胞),用ELISA法检测血清群体反应性抗体,免疫透射比浊法测定血清C反应蛋白,酶动力法检测血清肌酸肌酶。②混合淋巴细胞反应:以丝裂霉素C处理的供体外周血淋巴细胞作刺激细胞,3H-TDR掺入法检测患者外周血淋巴细胞对供体移植抗原的增生反应(阴性:刺激指数的均值与1无显著性差异,反之为阳性)。以自体相同处理过的外周血淋巴细胞代替供体刺激细胞作为对照,计算每一标本的刺激指数(刺激指数=实验cpm/对照cpm)作为比较指标。健康对照组20人均采外周血检测外周血T细胞亚群(CD3+,CD4+,CD8+T细胞)、血清群体反应性抗体、C反应蛋白和肌酸肌酶;20人随机分为10组,互为供受体,行外周血混合淋巴细胞反应。主要观察指标:①外周血T细胞亚群(CD3+,CD4+,CD8+T细胞)。②血清群体反应性抗体。③C反应蛋白。④肌酸肌酶。⑤混合淋巴细胞反应。结果:①术后1周内CD3+,CD4+,CD8+T细胞明显下降,1周后除CD8+细胞比术前升高外均逐渐恢复至术前水平[CD3+:(66.43±4.56);CD4+:(30.55±3.94);CD8+:(33.45±BACKGROUND： There are a lot of immunologic studies about limb allotransplantation in animal experiment. But, it is only early investigation in clinic; its clinical immunologic study needs further accumulation. OBJECTIVE： To dynamically analyze the early immunologic state change in patients following hand allotransplantation. DESIGN： Controlled trial. SETTING： Department of Orthopaedics, Guangzhou General Hospital, Guangzhou Military Area Command of Chinese PLA; Department of Traumatic Orthopaedics and Department of Laboratory Medicine, Nanfang Hospital, First Military Medical University of Chinese PLA. PARTICIPANTS： Two patients who underwent unilateral hand allotransplantation in the Department of Orthopaedics, Guangzhou General Hospital, Guangzhou Military Area Command of Chinese PLA were enrolled, serving as experimental group. The observation was between September 1999 and March 2000. Twenty persons, including 12 male and 8 female, who homochronously received health examination, aged 20 to 45 years, were enrolled, serving as healthy control group. They all had no reactive immune and infectious diseases, and voluntarily participated in the trial. METHODS： Peripheral blood was collected from 2 patients who underwent hand allotransplantation once respectively at pre-operative 1 day and 3 days. Blood collecting was performed once per day at post-operative 1 week, three times per week at post-operative 2 to 4 weeks, twice per week at 5 to 8 weeks post-operation, once per week at 9 to 16 weeks post-operation, twice per month at 5 to 6 months post-operation. ① Peripheral blood T cell subgroups （CD3^＋,CD4^＋ ,CD8^＋T cells）were detected by flow cytometer, serum panel reactive antibody （PRA） by ELISA method, serum C-reactive protein by turbidimetric immanoassay （TIA）, serum creatine kinase （CK） by enzyme dynamics method. ②Mixed lymphocyte reaction（MLR）： mitomycin C-treated donor peripheral blood lymphocytes were used as stimulator, and proliferative reaction of peripheral bloo

关 键 词：移植免疫学 移植 同种 手 

分 类 号：R658[医药卫生—外科学]