Immuknow法监测细胞免疫功能在诊断肾移植术后感染中的应用价值  

To study CD4＋ T lymphocytes cell function assay using the Immuknow in infections after renal transplantation

作　　者：张辉[1] 何军[2] 李杨[2] 浦金贤[1] 欧阳骏[1] 李刚[1] 侯建全[1] 

机构地区：[1]苏州大学附属第一医院泌尿外科,215006 [2]苏州大学附属第一医院江苏省血液研究所

出　　处：《中华泌尿外科杂志》2013年第7期538-541,共4页Chinese Journal of Urology

基　　金：国家自然科学基金（30872530,81072435）;科技部十二五重点项目（2011MSA01004）;江苏省医学重点学科（XK201151）;江苏省领军人才（LJ201138）;苏州市科技基础设施建设计划项目（SZS201001）

摘　　要：目的 使用Immuknow法监测肾移植术后受者CD＋T淋巴细胞内腺苷三磷酸（ATP）水平,探讨该方法在肾移植术后感染中的诊断价值及与药物谷浓度的相关性. 方法 选取2010年5月至2011年10月收治的肾移植受者45例,男33例,女12例.年龄21～58岁,平均（39±11）岁.根据术后是否发生感染将受者分为非感染组34例和感染组11例,感染组中肺部感染5例、上呼吸道感染4例、尿路感染1例、会阴部脓肿1例.选择健康志愿者23例作为对照组,男16例,女7例.使用Immuknow法检测各组的外周血中CD：T淋巴细胞内ATP水平.采用微粒酶联免疫法和荧光偏振免疫法检测他克莫司和环孢素的药物谷浓度.采用免疫比浊法检测受者血清中超敏C-反应蛋白浓度. 结果 对照组外周血中CD＋T淋巴细胞内ATP值为（295±74）μg/L,非感染组为（335±189）μg/L,感染组为（212±155）μg/L,感染组的ATP值明显低于对照组和非感染组,差异均有统计学意义（P＜0.05）.动态随访24例受者中5例发生感染,4例ATP值低于其术后随访的平均值.感染组血清C-反应蛋白浓度为（12.4±4.8） mg/L,明显高于非感染组的（3.3±4.7） mg/L和对照组的（0.5±0.5）mg/L,差异均有统计学意义（P＜0.05）.Immuknow法测得的ATP值与环孢素（r=0.07）和他克莫司（r=-0.02）的血药物谷浓度均无相关性（P＞0.05）. 结论 低ATP水平是肾移植术后感染的危险因素,使用Immuknow法监测受者的细胞免疫状态能弥补药物浓度监测的不足,指导临床调整免疫抑制剂用量.Objective To evaluate the value of ATP content of CD4＋T lymphocytes in the diag- nosis of infection and its correlation with drug concentrations in renal transplant recipients. Methods 45 renal transplant recipients were reviewed from May 2010 to October 2011. There were 33 males and 12 females, aged from 21 to 58 years old. The recipients were divided into non-infection group （n = 34） and infection group （n = 11） according to their clinical manifestation. 11 cases of infec- tion were diagnosed by the chest X-ray, CT imaging manifestations and etiological examination, a- mong them 5 cases were pulmonary infection, 4 cases were upper respiratory infection, 1 case was u- rinary tract infection and 1 case was perineal abscess. 23 healthy volunteers were enrolled as the con- trol group. They were detected ATP content of CD＋T lymphocytes by Immuknow method. The trough concentrations of the FK506 and CsA were detected by microparticle enzyme immunoassay and fluorescence polarization immunoassay, respectively. The hs-CRP concentration was detected by im- munoturbidimetry. Results The ATP content of CD＋T lymphocytes of the control group, non in- fection group and the infection group were （295±74）μg/L, （35±189） /lg/L and （212±155） μg/L respectively. The levels of ATP of infection group were obviously lower than the control group and non-- infection group. There were statistically differences （P 〈 0.05）. 24 recipients were followed up dynamicly. There were 4 cases whose ATP value was lower than the postoperative average levels in 5 infection recipients. The hs-CRP concentration of infection group were （12.4± 4.8） rag/L, obviously higher than the non infection groupIs （3.3 ±4.7） mg/L and the control groupr s （0.5 ± 0.5） mg/L. There were statistically differences （P〈0.05）. The ATP content of CD＋ T lymphocytes were no sig- nificant associated with drug trough concentrations （P〈0.05）. Conclusions Low ATP level after renal transplantation is a risk factor for inf

关 键 词：肾移植 感染 CD4阳性T淋巴细胞 腺苷三磷酸 

分 类 号：R699.2[医药卫生—泌尿科学]