低剂量免疫抑制剂对肾移植受者淋巴细胞表型的影响  

Evaluation of lymphocyte surface markers by flow cytometry in long term renal transplant recipients with different dosage of cyclosporine A immunosuppression

作　　者：肖家全[1] 唐孝达[2] 王祥慧[2] 徐达[2] 周佩军[2] 凡杰[2] 温文倩[2] 

机构地区：[1]东南大学附属中大医院泌尿外科,南京210009 [2]上海市第一人民医院肾移植中心

出　　处：《肾脏病与透析肾移植杂志》2001年第4期326-329,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金 (No .39870 70 6 )资助

摘　　要：目的 :探讨肾移植长期低剂量免疫抑制维持用药受者的免疫学特征。　 方法 :采用多种单克隆抗体 ,以流式细胞仪为工具 ,对存活 3年以上 ,长期低剂量免疫抑制维持用药受者、常规剂量维持用药受者和慢性移植肾失功受者的外周血淋巴细胞表型进行检测 ,分析细胞表型与临床用药量和移植效果的关系。　 结果 :低剂量受者CD95、NK及HLA DR阳性细胞数目与正常人接近 ,而在常规剂量组和移植肾失功能组中 ,CD95明显升高 ,NK细胞明显减少 (P <0 0 5 )。　 结论 :CD95、NK及HLA DR水平有可能用于评价长期移植受者的免疫状态 。Objective:Peripheral lymphocyte phenotypes have been investigated with respect to different immunosuppressive regimes and status of achieved immunotolerance.In this study,peripheral lymphocyte surface markers were evaluated in a cohort of long term survivors of renal transplantation,and difference investigated among stable recipients on low dosage cyclosporine A(CsA)regime,stable recipients on regular CsA regime,and those with chronic rejection on regular CsA regime. Methodology:This retrospective study included 28 stable recipients (RLD group)on low dosage cyclosporine A(CsA)regime(defined as half oral dosage of CsA intaked or half serum trough level achieved as compared to the regular CsA regime),28 stable recipients on regular CsA regime(RCD group),and 25 recipients(RCAF group)with chronic rejection on regular CsA regime (the mean serum creatinine level 264 5 μmol/L).All the peripheral cell surface markers were evaluated with flow cytometry.All the patients were treated with a same regime except the dosage of CsA.No difference was found among the three groups of patients in age,sex ratio,average survival,average cold ischemia time and peripheral neutrophil counts. Results:Decreased percentages of CD95 + and of HLA DR + cells and an increased percentage of NK cells(CD3 -/CD(16+56) +)were found in RLD group as compared to those in RCD and/or RCAF groups.No difference was found between the RLD group and the normal control in the percentage of CD95 +,or percentage of HLA DR + cells,or percentage of NK cells (CD3 -/CD(16+56) +).Differences in the percentage of other surface markers as CD3,CD4,CD8,CD28,CD80,CD86 were not found significant among the three groups of recipients. Conclusion:The percentages of CD95 cells,of NK cells and of HLA DR positive cells as evaluated by peripheral cell flow cytometry can be used as parameters to evaluate the immunosuppressive status in long term renal transplant recipients and may be used to optimize immunosuppressive regime.

关 键 词：肾移植 免疫 环孢素 低剂量免疫抑制剂 淋巴细胞表型 

分 类 号：R699.2[医药卫生—泌尿科学] R979.5[医药卫生—外科学]