器官移植病人外周血淋巴细胞表面蛋白分子表达与移植器官功能和活组织病理学改变时相比较  

Comparasion of the time phase changes of leukocytes’surface protein expression with the function of the transplantation organ or the time phase of histopathological changes in the organ transplantation patients

作　　者：许秀芳[1] 张颖[1] 辛毅[1] 黄益民[1] 顾云[1] 李娜[1] 孟旭[2] 伍冀湘[2] 周玉杰[2] 张兆光[2] 许学敏[2] 李京悻[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所分子生物学研究室,北京100029 [2]首都医科大学附属北京安贞医院外科,北京100029

出　　处：《安徽医药》2013年第7期1130-1135,共6页Anhui Medical and Pharmaceutical Journal

基　　金：首都医学发展科研基金(No ZB199814)

摘　　要：目的系统比较移植后外周血淋巴细胞表面蛋白分子表达时相与病理改变时相间的差别,探讨外周血淋巴细胞免疫活性变化与移植器官排斥反应时间进程间的关系。方法分别通过对临床4例肾移植、4例心脏移植和1例单肺移植病人的观察,利用病理学、流式细胞术等技术,系统比较了移植器官功能改变时相、移植器官的病理改变时相、外周血淋巴细胞表面蛋白分子表达时相的时间进程的差别和先后顺序。结果 (1)9例器官移植病人中有4例在发生急性排斥反应,免疫抑制剂不能完全阻断脏器移植排斥反应的发生;(2)肾移植术后早期,对外周血淋巴细胞表面蛋白分子CD3、CD4、CD8和TCR表达水平的监测可以帮助发现和判断急性排斥反应的时间进程,并可较准确地监测抗排冲击的疗效,减少免疫药物冲击疗程的盲目性;(3)心脏移植排斥反应病人淋巴细胞HLA-DR分子于移植后24～72 h期间出现高于没有排斥反应病人的表达高峰,比活组织检查诊断排斥反应时间提前5～7 d;(4)9例病人24 h内平均淋巴细胞表面蛋白分子CD3、CD4、CD8、HLA-DR、ICAM-I、MHC-Ⅱ、TCR等负调表达,淋巴细胞活性被一过性抑制;(5)9例病人24～48 h期间,平均淋巴细胞表面蛋白分子CD3、CD4、HLA-DR、ICAM-I、MHC-Ⅱ、TCR等正调表达。结论外周血淋巴细胞表面蛋白分子的测定对临床急性排斥反应的早期发现和时间进程的监测、抗排斥反应药物治疗效果的判断与监测具有一定的指导意义。Objective By systemically comparing the expressional time phase of leukocytes’surface proteins with the function of the transplantation organs and the time phase changes of histopathology in the organ transplantation patients to investigate the relationship of immunocompetence changes and time course of transplantation rejection.Methods Four cases of kidney transplantation,4 cases of heart transplantation,1 case of lung transplantation patients were enrolled.Time course and successive subsequence were compared among the transplantation function changes phase,transplantation pathological changes phase and expressional time phase changes of leukocytes’ surface proteins in the organ transplantation patients.Results In 4 of 9 cases there were different levels of rejection.Cyclosporine A was not able to block organ transplantation rejection.Early phase in kidney transplantation leukocytes’surface protein CD3,CD4,CD8,TCR were monitored to help the diagnoses of acute rejection and impacted curative effect of anti-rejection to reduce the blind action.In leukocytes’surface molecule HLA-DR there was one peak in 24 ～ 72 h in heart transplantation,which was 5 ～ 7 d in advance before rejection by biopsy technique.In 24 h after transplantation leukocytes’surface proteins CD3,CD4,CD8,HLA-DR,ICAM-I,MHC-Ⅱ,TCR were expressed negatively in 9 patients and leukocytes’active activities were temporarily inhibited in 24 h after the operation.In 24 ～ 48 h leukocytes’surface molecules CD3,CD4,HLA-DR,ICAM-I,MHC-Ⅱ,TCR were expressed positively,which indicate that leukocytes started translation and molecular synthesis process.Conclusion Detection of the expression levels of leukocytes’surface molecules might be helpful in prediction of early detection of clinical acute rejection,the time course monitoring,and the effect of anti-rejection drugs.

关 键 词：脏器移植 外周血淋巴细胞 表面蛋白分子表达时相 

分 类 号：R617[医药卫生—外科学]