同种异体心脏移植急性排斥反应的无创监测  

Noninvasive monitoring of acute rejection after allogenic cardiac transplantation

作　　者：马涛[1] 胡军[1] 蔡振杰[1] 李彤[1] 王晓武[1] 程亮[1] 

机构地区：[1]第四军医大学西京医院心血管外科,陕西西安710033

出　　处：《第四军医大学学报》2008年第11期1027-1030,共4页Journal of the Fourth Military Medical University

摘　　要：目的:观察同种异体心脏移植术后血清C-反应蛋白(CRP)的动态变化,探讨监测其血清浓度水平在评价移植成活质量及判断心脏排斥反应的作用.并研究体外单项混合淋巴细胞培养作为无创心脏移植排斥反应监测方法及意义.方法:26例原位心脏移植患者手术前后及心内膜心肌活检(EMB)时同期监测受体血清CRP浓度水平,依术后30d内受体是否成活分为成活组(n=24)与死亡组(n=2);依EMB标本(n=32)病理等级(ISHLT)分为阴性组(0,1a,n=24)和排斥组(1b,>1b,n=8).通过改良的单向混合淋巴细胞培养与心肌内膜活检(EMB)相对照,测定淋巴细胞活性与心肌活检病理等级的相关性.结果:CRP值在移植早期随着手术创伤的恢复而降低,成活组与死亡组在后期CRP水平差别明显.阴性组与排斥组两组间CRP水平有明显的差异(P<0.05),心脏排斥反应发生时血浆中CRP浓度水平升高.改良的体外单项混合淋巴细胞培养结果与心肌内膜活检病理等级有很好的相似性.结论:CRP可作为判断心脏移植早期成活质量的标志,对监测心脏移植术后有否可能的排斥反应有一定的提示意义.改良的体外单向混合淋巴细胞培养方法可作为无创监测心脏移植排斥反应的有效手段之一.AIM： To investigate the dynamic change of serum level of the acute phase reactant, C-reactive protein, after allogenie cardiac transplantation, to determine its roles in evaluating surviving quality and cardiac rejection post-transplantation and to research the feasibility of mixed lymphocytes culture as non-invasive surveillance of acute rejection after cardiac transplantation and its significance. METHODS： Serum level of CRP was measured in 26 patients, who were then divided into 2 groups： those died within 30 d after cardiac transplantation （ dead group, n = 2 ） and those survived （ surviving group, n = 24）. During the followup period of 1.0 ± 1.7 years （ ranging from 0.3 to 4.3 years ） after transplantation, 32 routine endomyocardial biopsy （EMB） samples were divided into 2 groups according to International Society of Heart and Lung Transplantation （ISHLT） ： the rejection group （ 1b, 〉 1b, n = 8 ） and the negative group （0, 1 a, n = 24 ）. We compared the results of modified mixed lymphocytes culture and EMB and analysed their correlation. RESULTS： CRP reached the peak on the 4th day in all patients postoperation, and declined on day 8 - 14 postoperatively. CRP level was significantly higher in dead group than in surviving group E （187.5 ±21.2） vs （18.7±18.6） mg/L, P〈0.001]. Moreover, there was significant difference in CRP level between the rejection group and the negative group [ （14.26 ± 9.08） vs （4.81 ± 2.36） mg/L, P 〈 0.05 ]. CRP level was also correlated significantly with the frequency of acute graft rejection （ P = 0.02 ）. Modified mixed lymphocytes culture had very close correlation with EMB, which was valuable for the early diagnosis of rejection. CONCLUSION： The increased CRP is predictive of the early diagnosis of acute rejection after cardiac transplantation. Modified mixed lymphocytes culture can efficaciously detect acute cardiac rejection,and can be taken as one of non-invasive methods to monitor acute rejection.

关 键 词：心脏移植 C-反应蛋白 混合淋巴细胞培养 急性排斥反应 

分 类 号：R654.2[医药卫生—外科学]