肾移植患者外周血白细胞的动态监测  

Dynamic monitoring of leukocytes in patients undergoing renal transplantation

作　　者：陈远林[1] 唐亚梅[1] 姚冬梅[1] 

机构地区：[1]中南大学湘雅二医院检验科,湖南省长沙市410011

出　　处：《中国组织工程研究与临床康复》2008年第31期6031-6034,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:研究表明,肾移植患者外周血白细胞的动态变化与某些并发症的发生有一定关系。目的:应用全自动血细胞分析仪动态监测肾移植患者外周血白细胞数量和形态的变化,分析其与移植后机体感染、免疫抑制剂中毒及急性排斥反应发生的关系。设计、时间及地点:观察对比实验,于2004-06/2005-10在中南大学湘雅二医院完成。对象:选择同种异体肾移植患者64例,根据移植后临床症状及实验室生化指标、X射线、B超、肾穿刺组织活检结果,将患者分为4组,稳定组36例,感染组9例,免疫抑制剂中毒组6例,急性排斥反应组13例。方法:采用SysmexXE-2100全自动血液分析仪对肾移植后患者外周血行连续血常规检测,结合手工血涂片进行形态学观察和分析,同时采用日立7600全自动生化分析仪连续检测患者肝功能和肾功能。主要观察指标:观察各组患者外周血白细胞数量、形态学变化及肝、肾功能变化。结果:①稳定组和免疫抑制剂中毒组患者外周血白细胞计数正常,感染组和急性排斥反应组白细胞计数高于稳定组(P<0.05)。②XE-2100出现多种白细胞形态异常提示信号:白细胞散射图异常、出现原始粒细胞、出现未成熟粒细胞、核左移、不典型淋巴细胞等,手工血涂片显微镜检亦发现白细胞形态有明显改变。各组患者外周血白细胞形态学改变有明显差异。③各组患者肝功能均正常,稳定组和感染组肾功能正常,免疫抑制剂中毒组和急性排斥反应组血清尿素氮和肌酐含量高于稳定组(P<0.05)。结论:肾移植后出现不同并发症的患者,其外周血白细胞形态改变各有特点,借助SysmexXE-2100血液分析仪上特有的Q-Flag报警系统提供的信息,有助于移植后炎症感染、药物中毒及排斥反应的早期筛选、辅助诊断和鉴别诊断。BACKGROUND： Changes of leukocytes are related with some postoperative complications after renal transplantation. OBJECTIVE： To observe dynamically the level of white blood cell （WBC） and its morphological changes using automatic blood cell analyzer to evaluate its relationship with infection, immunosuppressive intoxation and acute rejection. DESIGN, TIME AND SETTING： Observation and controlled trial was performed at Second Xiangya Hospital, Central South University from June 2004 to October 2005. PARTICIPANTS： Sixty-eight patients who received renal transplantation were selected. According to clinical symptoms and laboratory biochemical indexes, X-ray, B ultrasound, and renal puncture biopsy, the patients were divided into stable group （n=36）, infection group （n=9）, intoxation group （n=6） and acute rejection group （n= 13）. METHODS： The blood routine was tested with Sysmex XE-2100 automatic blood analyzer following renal transplantation and WBC manual differentiation was done to observe peripheral blood morphology, their liver function. In addition, renal and liver functions were detected by automatic biochemical system 7600A. MAIN OUTCOME MEASURES： WBC count and its morphological changes in peripheral blood and liver and renal function after renal transplantation. RESULTS： WBC count of the stable group and intoxation group was normal, and that of the acute rejection group and infection group were significantly higher than the stable group （P 〈 0.05）. Many kinds different morphology was showed on XE-2100 including WBC-A-S, Blasts, Imm Gran, left shift, atypical lymph et al. Leukocytes morphological changes was obvious under microscope and there were significant differences among different groups. Liver function of each group was normal. Renal function of the stable and infection groups was normal, while serum urea nitrogen and creatinine contents in intoxation and acute rejections groups were markedly higher than the stable group （P 〈 0.05）. CONCLUSION： P

关 键 词：肾移植 白细胞 移植物排斥 器官移植 

分 类 号：R617[医药卫生—外科学]