外周血清趋化因子IP-10和Fractalkine及其受体在早期诊断移植肾急性排斥反应的应用  

Application of IP-10,Fractalkine and their receptors in early diagnosis of acute rejection in transplanted kidney

作　　者：刘一帆[1] 苏泽轩[2] 张清[2] 石利平[2] 程云华[2] 

机构地区：[1]广州医科大学附属第五医院泌尿外科,广州510700 [2]暨南大学附属第一医院泌尿外科

出　　处：《山西医科大学学报》2015年第8期804-809,共6页Journal of Shanxi Medical University

基　　金：广东省自然科学基金资助项目(SZR023495)

摘　　要：目的 探讨肾移植术后外周血趋化因子IP-10和Fractalkine及其受体术后动态变化和早期预测肾移植排斥的应用价值. 方法 前瞻性地收集2009-01～2012-03在暨南大学附属第一医院行同种异体肾移植术的患者52例,排除感染及其他感染因素后根据术后临床表现及移植肾穿刺病理学检查,分为急性排斥反应（acute rejection,AR,n=15）组与非急性排斥（non-acute rejection,NAR,n=35）组,测定两组患者术前ld以及术后1,3,5,9d的外周血IP-10及受体CXCR3和Fractalkine及受体CX3CR1的表达情况.采用ROC曲线评价标记物准确度并计算其曲线下总面积（area under curve,AUC）. 结果 共有15例在肾移植术后发生急性排斥反应（acute rejection,AR）,AR组的IP-10及受体CXCR3、Fractalkine及受体CX3CR1均比术前增高,且差异有统计学意义（P＜0.05）.AR组的IP-10、CXCR3及CX3CR1在术后各个检测点均显著高于NAR组,而Fractalkine在术后5d内均显著高于NAR组.IP-10在预测急性排斥反应的AUC值为0.74（95％ CI 0.57-0.91）,而Fractakine则为0.75（95％ CI 0.61-0.89）,联合IP-10与Fractakine预测急性排斥反应具有最大的ROC曲线下总面积,AUC值提高至0.86（95％CI 0.77-0.96）. 结论 血清中趋化因子IP-10及受体、Fractalkine及受体与急性排斥反应密切相关,预测价值较高,有望成为早期诊断肾移植急性排斥反应的新型无创检测方法.Objective To investigate the dynamic changes of serum concentrations of IP-10,Fractalkine,and their receptors（CXCR3 and CX3CR1） and explore their early predictive value for acute allograft rejection in kidney transplant recipients.Methods Fifty-two recipients with allograft renal transplantation were enrolled in this study and divide into acute rejection group（AR,n =15） and non-acute rejection group（NAR,n =35）.Serum samples from recipients were collected 1 d prior to transplantation and 1,3,5,7,9 d after transplantation.The accuracy of chemokine concentrations for predicting acute rejection was evaluated using receiver operator characteristic（ROC） curves.Results AR happened in 15 patients after transplantation.Serum Fractalkine,CXCR1,IP-10,and CXCR3 levels increased in AR group after transplantation.Serum CXCR1,IP-10,and CXCR3 levels were significantly higher in AR group than in NAR group after transplantation,and Fractalkine was also higher within 5 d after transplantation.Area under ROC was 0.74（95％CI 0.57-0.91）for IP-10,0.75（95％CI 0.61-0.89） for Fractalkine,and 0.86（95％ CI 0.77-0.96） for Fractalkine combined with IP-10.Conclusion Serum levels of Fractalkine,IP-10 and their receptors are closely related with AR,and they may serve as a non-invasive approach for the early diagnosis of renal allograft rejection,especially combination of Fractalkine and IP-10.

关 键 词：急性排斥 FRACTALKINE IP-10 CX3CR1 CXCR3 肾移植 

分 类 号：R692[医药卫生—泌尿科学]