肾移植后淋巴细胞亚群的变化及其对诊断急性排斥反应和CMV感染的意义  

Clinical application of lymphocytes subsets monitoring in differential diagnosis of acute rejection and CMV infection in kidney transplant recipients

作　　者：王旭珍[1] 薛武军[1] 田晓辉[1] 郑瑾[1] 田普训[1] 丁小明[1] 景鑫[1] 罗自珍 

机构地区：[1]西安交通大学医学院第一附属医院肾移植科,710061

出　　处：《中华器官移植杂志》2013年第11期651-654,共4页Chinese Journal of Organ Transplantation

基　　金：国家重点基础研究计划“973计划”（2009CB522407）

摘　　要：目的探讨肾移植后淋巴细胞亚群的动态变化对诊断急性排斥反应（AR）和巨细胞病毒（CMV）感染意义。方法选择符合纳入标准的肾移植受者79例，其中52例肾功能恢复顺利，12例发生AR，15例发生CMV感染。采用流式细胞技术对3组受者外周血淋巴细胞亚群进行动态监测。3组受者在围手术期均应用了抗人T淋巴细胞免疫球蛋白行免疫诱导，术后常规采用环孢素A（或他克莫司）＋吗替麦考酚酯＋泼尼松的三联免疫抑制方案。结果AR组CD3＋CD4＋T淋巴细胞百分比为（48．75±8．77）％，显著高于肾功能稳定组的（39．73±8．59）％（P〈0．05）及CMV组的（31．54±11．09）％（P〈0．05）；CMV组CD3＋CD8＋T淋巴细胞百分比为（42．48±13．77）％，高于肾功能稳定组的（28．96±9．08）％（P〈0．05）及AR组的（17．47±5．92）％（P〈0．05）；肾功能稳定组、AR组和CMV组的CD4＋T淋巴细胞与CD8＋T淋巴细胞比值（CD4／CD8比值）分别为1．75±0．98、2．89±0．69和0．63±0．31；NK细胞百分比分别为（8．47±4．33）％、（15．24±5．89）％和（4．67±1．89）％，AR组和CMV组与肾功能稳定组相比较，差异均有统计学意义（P〈0．05）。AR缓解后受者外周血CD4／CD8比值及NK细胞百分比分别为1．76±0．50和10．72±6．79％，较发病时显著降低（P〈0．05）。结论检测肾移植受者外周血淋巴细胞亚群，特别是CIN／CD8比值及NK细胞的动态变化，对AR及CMV感染的诊断具有临床价值，对于个体化免疫抑制治疗具有一定指导意义。Objective To study the applied value of peripheral blood lymphocytes subsets monitoring in diagnosis of acute rejection （AR） and CMV infection in kidney transplant recipients. Method Seventy-nine kidney transplant recipients （52 cases of stable renal function, 15 cases of AR, and 12 cases of CMV infection） were enrolled in this study according to the selection criteria. The lymphocyte subsets in peripheral blood were examined dynamically by flow cytometer. All the recipients received ATG induction therapy, and a triple-drug immunosuppressive regimen （CsA/Tac ＋ MMF＋Pred） was given to all the patients. Results The percentage of CD3＋ CD4＋ cells in stable group, AR group and CMV infection group was 39. 73 ± 8.59, 48.75 ± 8. 77, and 31.54 ± 11.09 respectively, of which the percentage of CD3＋ CD4＋ cells in AR group was significantly higher than that in stable group and CMV infection group （P〈0. 05）. The percentage of CD3＋ CD8＋ cells in stable group, AR group and CMV infection group was 28. 96 ± 9. 08, 17. 47 ± 5.92 and 42. 48± 13. 77 respectively, of which the percentage of CD3＋ CD8＋ cells in CMV infection group was significantly higher than that in stable group and AR group （P〈0. 05）. The ratio of CD4/CD8 in in stable group, AR group and CMV infection group was 1.75 ± 0. 98, 2. 89 ± 0. 69 and 0. 63 ± 0. 31 respectively, while the percentage of NK cells was 8. 47 ± 4. 33, 15.24±5.89 and 4. 67 ±1. 89 respectively, with significant differences between the groups （P 〈 0. 05 ）. The ratio of CD4/CD8 and NK cells was decreased to （ 1.76 ± 0. 50） and （10. 72 ± 6. 79） % respectively after remission of AR group as compared with that at the onset of AIR （P〈0. 05）. Conclusion The monitoring of peripheral blood lymphocyte subsets, especially the dynamic changes of CD4/CD8 and NK ceils, was of significance in the diagnosis of AR and CMV infection and the individualized immunosuppressive therapy for kidney transplant recipients.

关 键 词：肾移植 排斥反应 巨细胞病毒 淋巴细胞亚群 

分 类 号：R446.6[医药卫生—诊断学]