分泌干扰素-γ的效应T细胞在预警肾移植术后急性排斥反应中的意义  被引量:1

Significance of effector T cell secreting interferon-γ on early warning of acute rejection after renal transplantation

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作  者:毛天赐[1] 田普训[1] 薛武军[1] 潘晓鸣[1] 项和立[1] 丁晨光[1] 靳占奎[1] 段万里[1] 席敏[1] 

机构地区:[1]西安交通大学医学院第一附属医院肾脏病医院肾移植科,710061

出  处:《器官移植》2013年第6期325-330,共6页Organ Transplantation

基  金:陕西省13115重大科技攻关资助项目(S2009ZDKG138)

摘  要:目的探讨肾移植术后早期外周血中分泌干扰素(IFN)-γ的效应T细胞数量变化在预警急性排斥反应(AR)中的意义。方法本前瞻性对照非连续性研究对象选取2011年1月1日至2012年12月31日在西安交通大学医学院第一附属医院肾移植科收治的200例同种异体肾移植患者。根据移植后临床表现、实验室检查及肾穿刺病理学检查结果分为两组:AR组(24例)和移植肾功能正常(stable allograft function,STA)组(176例)。其中AR组根据病理严重程度再分为Ⅰ级(9例)、ⅡA级(7例)、ⅡB级(4例)、Ⅲ级(4例)4种等级。另外随机选择行活体亲属肾移植供者为健康对照(healthy control,HC)组(10例)。3组分别于术前1 d,术后1、3、5、7、14、21、28、60、90 d留取外周血;另外AR组于临床拟诊AR当日开始留取外周血,即0、1、3、5、7、14、21、28 d。通过体外刺激因子佛波酯(phorbol myfismte acetate,PMA)和离子霉素(ionomycin,Ion)刺激外周血淋巴细胞释放IFN-γ,采用酶联免疫斑点试验(enzyme linked-immunospot assay,ELISPOT)方法,动态监测外周血分泌IFN-γ的效应T细胞数量(IFN-γELISPOT值)。比较3组研究对象外周血中IFN-γELISPOT值的动态变化;采用受试者工作特征(ROC)曲线分析IFN-γELISPOT值对AR的诊断效果;比较AR组患者冲击治疗前后IFN-γELISPOT值的动态变化;比较AR组中不同病理分级患者的IFN-γELISPOT值的动态变化,以分析IFN-γELISPOT值与AR病理分级的关系。结果术后1、2、4 d,AR组和STA组的IFN-γELISPOT值明显高于HC组(均为P<0.05),肾移植术后1、2、4、7、14、21 d,AR组的IFN-γELISPOT值均明显高于STA组(均为P<0.05)。IFN-γELISPOT值诊断AR的ROC曲线下面积(area under the curve,AUC)为0.92,最佳临界值为23 spots/5×105PBLs,其评价AR的灵敏度为0.920,特异度为0.875。在诊断前3 d、前1 d及穿刺当日,4组患者之间IFN-γELISPOT值的差异有统计学意义(均为P<0.05)。在AR发生前7 d内,IFN-γELISPOT值上升Objective To investigate the significance of dynamic changing of effector T cell secreting interferon (IFN) -γ in peripheral blood on early warning of acute rejection (AR) after renal transplantation. Methods Two hundred allogenetic renal transplant recipients were selected in the prospective study, who were treated in Department of Renal Transplantation of the First Affiliated Hospital of Medical College in Xi'an Jiaotong University from January 1, 2011 to December 31, 2012. According to the clinical manifestation,laboratmT examination and pathological biopsy examination results, 200 recipients were divided into AR group (n =24) and stable renal function (STA) group (n = 176). And recipients in AR group were divided into 4 grades: grade Ⅰ (n=9), grade ⅡA (n=7), grade ⅡB (n=4), gradem (n=4), according to severity of pathology. Another 10 donors of living relative renal transplantation were selected as healthy control (HC) group. Peripheral blood of cases in 3 groups was taken at 1 d before operation and at 1, 3, 5, 7, 14, 21, 28, 60, 90 d after operation. And peripheral blood of cases in AR group was taken at 0, 1, 3, 5, 7, 14, 21, 28 d after clinical suspected diagnosis of AR. The stimulating factors in vitro, phorbol myfismte acetate (PMA) and ionomycin (Ion) , were used to stimulate peripheral blood lymphocyte to release IFN-3,. Enzyme linked-immunospot assay (ELISPOT) was used to detect the counts of effector T cell(IFN-γ ELISPOT value). The dynamic change of IFN-γ ELISPOT value was compared among 3 groups. Receiver operating characteristic (ROC) curve was used to analyze the diagnosis effect of IFN-γ ELISPOT value on AR. The changes of IFN-γ ELISPOT values in AR group were compared before and after impact therapy. The changes of IFN-γ ELISPOT values of patients with different pathological grades in AR group were compared to analyze the relationship between IFN-γ ELISPOT value and AR pathological grading. Results The IFN-γ ELISPOT v

关 键 词:急性排斥反应 肾移植 干扰素 酶联免疫斑点试验 佛波酯 离子霉素 体外刺激 

分 类 号:R617[医药卫生—外科学]

 

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