外周血淋巴细胞亚群绝对值和功能的动态监测在肾移植术后早期病毒感染风险预测中的价值  

Value of dynamic monitoring of absolute value and function of peripheral blood lymphocyte subsets in predicting the risk of early viral infection after kidney transplantation

作　　者：张倩倩 谢亚龙 汪峰 罗颖 陈松[1] 张伟杰[1] 昌盛[1] Zhang Qianqian;Xie Yalong;Wang Feng;Luo Ying;Chen Song;Zhang Weijie;Chang Sheng(Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation of Ministry of Education,Key Laboratory of Organ Transplantation of National Health Commission of China,Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences,Wuhan 430030,China;不详)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所器官移植教育部重点实验室国家卫生健康委员会器官移植重点实验室中国医学科学院器官移植重点实验室,武汉430030 [2]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《器官移植》2022年第1期80-87,共8页Organ Transplantation

基　　金：国家自然科学基金面上项目(81873511);中国器官移植发展基金会“移植领创计划”(YZLC-2021-005);湖北省卫生计生科研项目(WJ2019Z007)。

摘　　要：目的探讨不同淋巴细胞亚群的绝对值和功能对于评估肾移植受者术后早期发生病毒感染风险的预测和诊断价值。方法将95例肾移植受者纳入前瞻性观察队列研究,根据术后的免疫状态分为稳定组(77例)和感染组(18例)。分别于术前、术后2周、术后1个月、术后2个月、术后6个月采集外周血样本进行流式细胞检测。比较两组CD4^(+)T细胞、CD8^(+)T细胞、自然杀伤(NK)细胞绝对值的动态变化,通过检测干扰素(IFN)-γ^(+)CD4^(+)T细胞、IFN-γ^(+)CD8^(+)T细胞、IFN-γ^(+)NK细胞比例分析两组受者淋巴细胞亚群功能,评估淋巴细胞亚群绝对值和功能在肾移植术后早期对病毒感染的预测和诊断价值。结果在病毒感染时,感染组的CD4^(+)T细胞、CD8^(+)T细胞、NK细胞绝对值整体处于相对较低的水平;在术后2个月时,感染组的CD4^(+)T细胞、NK细胞绝对值均低于稳定组;在术后6个月时,感染组的CD4^(+)T细胞、CD8^(+)T细胞绝对值均低于稳定组(均为P<0.05)。在病毒感染时,感染组的IFN-γ^(+)CD4^(+)T细胞、IFN-γ^(+)CD8^(+)T细胞、IFN-γ^(+)NK细胞比例均处于相对较低的水平,尤以IFN-γ^(+)CD8^(+)T细胞比例降低最为显著;在术后2个月,感染组的IFN-γ^(+)CD8^(+)T细胞、IFN-γ^(+)NK细胞比例显著高于稳定组;在术后6个月,感染组的IFN-γ^(+)CD4^(+)T细胞、IFN-γ^(+)CD8^(+)T细胞比例均高于稳定组(均为P<0.05)。logistic回归分析结果显示,术后2个月时,IFN-γ^(+)CD8^(+)T细胞和IFN-γ^(+)NK细胞比例的升高与病毒感染风险增加均相关(均为P<0.05)。受试者工作特征(ROC)曲线结果表明,淋巴细胞亚群绝对值联合其IFN-γ分泌功能对于免疫状态低下的受者病毒感染的诊断价值显著高于单用淋巴细胞亚群绝对值(P<0.05)。结论动态监测淋巴细胞亚群绝对值和功能的变化对病毒感染的预测、诊断及指导用药具有重要参考价值。Objective To investigate the predictive and diagnostic value of absolute value and function of different lymphocyte subsets in evaluating the risk of early viral infection after kidney transplantation.Methods Ninety-five kidney transplant recipients were enrolled in this prospective observational cohort study,and divided into the stable group(n=77)and infection group(n=18)according to postoperative immune status.Peripheral blood samples were collected for flow cytometry before operation,and 2 weeks,1 month,2 months and 6 months after operation.The dynamic changes of the absolute values of CD4^(+)T cells,CD8^(+)T cells and natural killer(NK)cells were compared between two groups.The function of lymphocyte subsets in two groups was evaluated by detecting the proportion of interferon(IFN)-γ^(+)CD4^(+)T cells,IFN-γ^(+)CD8^(+)T cells and IFN-γ^(+)NK cells.The value of the absolute values and function of lymphocyte subsets in predicting and diagnosing viral infection in the early stage after kidney transplantation was evaluated.Results During viral infection,the absolute values of CD4^(+)T cells,CD8^(+)T cells and NK cells in the infection group were at a relatively low level.At 2 months after operation,the absolute values of CD4^(+)T cells and NK cells in the infection group were lower than those in the stable group.At 6 months after operation,the absolute values of CD4^(+)T cells and CD8^(+)T cells in the infection group were significantly lower compared with those in the stable group(all P<0.05).During viral infection,the proportion of IFN-γ^(+)CD4^(+)T cells,IFN-γ^(+)CD8^(+)T cells and IFN-γ^(+)NK cells in the infection group were all at a relatively low level,especially that of IFN-γ^(+)CD8^(+)T cells decreased most significantly.At postoperative 2 months,the proportion of IFN-γ^(+)CD8^(+)T cells and IFN-γ^(+)NK cells in the infection group was significantly higher than those in the stable group.At 6 months after operation,the proportion of IFN-γ^(+)CD4^(+)T cells and IFN-γ^(+)CD8^(+)T cells in the infe

关 键 词：肾移植 免疫监测 淋巴细胞亚群 流式细胞术 外周血单个核细胞 干扰素-Γ 个体化治疗 CD4~+T细胞 CD8~+T细胞 自然杀伤细胞 

分 类 号：R617[医药卫生—外科学] R619.3[医药卫生—临床医学]