肾移植术后巨细胞病毒性肺炎患者CD4^+细胞三磷酸腺苷浓度测定及其意义  

Clinical value of ATP determination in CD4^+ cells of patients with cytomegaloviral pneumonia after kidney transplantation

作　　者：张长征[1,2] 聂海波 朱云松[2] 陈政良[1] 胡卫列[2] 

机构地区：[1]南方医科大学免疫学教研室,广东广州510515 [2]广州军区广州总医院泌尿外科,广东广州510010

出　　处：《南方医科大学学报》2010年第5期1092-1094,共3页Journal of Southern Medical University

摘　　要：目的探讨CD4+细胞三磷酸腺苷(ATP)浓度测定在肾移植术后巨细胞病毒性肺炎治疗中的意义。方法选择2007年7月～2009年7月在我院进行的180例肾移植受者中发生巨细胞病毒性肺炎的28例患者及30例正常志愿者。采用ATP生物发光法测定通过植物血凝素(PHA)刺激后的CD4+细胞ATP浓度的变化观察手术前后(0、1、2、4周)及治疗前后(0、2、4周)受者免疫功能变化。结果肾移植受者术前CD4+细胞ATP浓度为(402±58)ng/ml,明显低于正常志愿者的(458±196)ng/ml(P<0.05),术后1周左右降至最低,采用抗体诱导者尤其明显;2周左右开始回升,4周时仍低于术前水平(P<0.05),抗体诱导者回升相对较慢。并发巨细胞病毒性肺炎时,CD4+细胞ATP浓度下降,且略低于术后1周水平,但无统计学差异(P>0.05),明显低于术前水平(P<0.01),病情加重时下降更加明显;治疗好转后(治疗后2周)ATP浓度有所回升,4周后仍低于术前水平(P<0.05)。结论 CD4+细胞ATP浓度可较准确地反映肾移植受者巨细胞病毒性肺炎时的整体细胞免疫功能状态,对巨细胞病毒性肺炎有预示和监测作用,能更好地指导临床治疗方案的制定。Objective To explore the clinical value of determination of ATP levels in CD4＋ cells of patients with cytomegaloviral pneumonia after kidney transplantation. Methods Twenty-eight patients with cytomegaloviral pneumonia following kidney transplantation and 30 healthy volunteers were enrolled in this study. ATP-bioluminescence assay （ATP-CVA） was used to assess the immune response of CD4＋ cells to phytohemagglutinin （PHA） stimulation in the normal volunteers and the recipients （before and at 1, 2, and 4 weeks after renal transplantation, before and at 2 and 4 week after the treatment）. Results ATP concentration in CD4＋ cells of the recipients was 402±58 ng/ml before the operation, significantly lower than that in normal volunteers （458±196 ng/ml, P0.05）, and reached the lowest level in the first week after operation especially in the recipients with antibody-inducing therapy; ATP level increased slowly since week 2 post-operation, but still remained significantly lower than the preoperative by the fourth week （266±87 ng/ml, P0.05）, especially in the recipients receiving antibody-inducing therapy. In the event of cytomegaloviral pneumonia, ATP level underwent a mild reduction to152±78 ng/ml in comparison with the postoperative level at the first week （P0.05）, and was significantly lower than preoperative level （P0.01）; the decrease was especially obvious during the exacerbation of the condition. ATP level then increased slowly after effective treatment, but was still lower than the preoperative level at 4 weeks after the operation （336± 92 ng/ml, P0.05）. Conclusion The determination of ATP level in CD4＋ cells allows more accurate assessment of the cellular immunity in the renal transplant recipients with cytomegaloviral pneumonia to help in the clinical treatment of the patients.

关 键 词：肾移植 巨细胞病毒 肺炎 CD4+细胞 三磷酸腺苷 

分 类 号：R699.2[医药卫生—泌尿科学] R563.1[医药卫生—外科学]