CD19^(+)CD24^(hi)CD38^(hi) B细胞比例预测肝移植术后急性细胞性排斥反应发生的临床研究  

Clinical study on the role of the proportion of CD19^(+)CD24^(hi)CD38^(hi) B cells for predicting the occurrence of acute cellular rejection after liver transplantation

作　　者：沈恬[1] 郑珊华 刘征涛 耿磊[1] 郑树森[1,2] 徐骁 Shen Tian;Zheng Shanhua;Liu Zhengtao;Geng Lei;Zheng Shusen;Xu Xiao(NHC Key Laboratory of Combined Multi-Organ Transplantation,the First Affiliated Hospital,Zhejiang University School of Medicine,Zhejiang Province Key Laboratory of Organ Transplantationthe,Hangzhou 310003,China;Department of Hepatobiliary and Pancreatic Surgery,Shulan(Hangzhou)Hospital,Hangzhou 310022,China;Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hangzhou First People1's Hospital,Zhejiang University School of Medicine,Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属第一医院卫生部多器官联合移植重点实验室浙江省器官移植重点实验室,杭州310003 [2]树兰(杭州)医院肝胆胰外科,310022 [3]浙江大学医学院附属杭州市第一人民医院肝胆胰外科浙江省肿瘤融合研究与智能医学重点实验室,310006

出　　处：《中华移植杂志（电子版）》2022年第1期27-31,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金重点项目(81930016)。

摘　　要：目的:分析肝移植术后受者外周血CD19^(+)CD24^(hi)CD38^(hi) B细胞占单个核细胞比例变化情况及其与急性细胞性排斥反应(ACR)之间的关系。方法:回顾性分析2013年12月至2015年12月在浙江大学医学院附属第一医院接受心脏死亡器官捐献肝移植的80例成人受者临床资料,根据术后是否发生ACR,将受者分为ACR组(25例)和非ACR组(55例)。术前、术后各个时间点抽取参加研究者静脉血并分离外周血单个核细胞,加入异硫氰酸荧光素-单克隆鼠抗人CD19抗体、藻红蛋白-单克隆鼠抗人CD24抗体和别藻蓝蛋白-单克隆鼠抗人CD38抗体,流式细胞仪检测各组CD19^(+)CD24^(hi)CD38^(hi) B细胞百分比。采用t检验和单因素方差分析比较正态分布计量资料,采用χ^(2)检验比较计数资料,采用Kaplan-Meier法绘制受试者工作特征曲线(ROC曲线)。P<0.05为差异有统计学意义。结果:ACR组、非ACR组受者术前外周血平均CD19^(+)CD24^(hi)CD38^(hi) B细胞比例分别为(3.13±0.91)%、(3.49±0.83)%,差异无统计学意义(t=1.636,P>0.05)。ACR组术后发生ACR前外周血平均CD19^(+)CD24^(hi)CD38^(hi) B细胞比例为(1.87±0.70)%。非ACR组受者术后3个月、6个月和1年外周血平均CD19^(+)CD24^(hi)CD38^(hi) B细胞比例分别为(1.64±0.52)%、(1.63±0.56)%和(2.04±1.24)%,术后3、6个月平均值均低于术前和术后1年,差异均有统计学意义(P均<0.05)。ACR组受者发生ACR时外周血平均CD19^(+)CD24^(hi)CD38^(hi) B细胞比例为(0.8±0.5)%,低于发生ACR前的平均水平(t=5.752,P<0.05),且低于非ACR组术后3个月、6个月和1年的平均水平(P<0.05)。ACR组受者接受抗排斥反应治疗后,CD19^(+)CD24^(hi)CD38^(hi) B细胞比例也逐渐增加,ACR发生后7 d为(0.84±0.08)%,与ACR发生时相比差异无统计学意义(P>0.05);而发生30 d后达(1.65±0.18)%,与ACR发生时相比差异有统计学意义(P<0.05)。当截断值为1.015%时,CD19^(+)CD24^(hi)CD38^(hi) B细胞比例预测ACR发生的敏感度和�Objective:To analyze the proportion change of CD19^(+)CD24^(hi)CD38^(hi) B cells to mononuclear cells in peripheral blood of liver transplant recipients and its relationship with acute cellular rejection (ACR) after liver transplantation.Methods:The clinical data of 80 adult recipients of liver transplantation after cardiac death donation in the First Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2015 were retrospectively analyzed. According to the occurrence of ACR, the recipients were divided into ACR group (25 cases) and non-ACR group (55 cases). The venous blood of the participants was collected and the peripheral blood mononuclear cells were isolated. FITC-monoclonal mouse anti-human CD19 antibody, PE-monoclonal mouse anti-human CD24 antibody and APC-monoclonal mouse anti-human CD38 antibody were added. The percentage of CD19^(+)CD24^(hi)CD38^(hi) B cells in each group was detected by flow cytometry. The measurement data conforming to normal distribution were compared by group t test or one-way ANOVA, the counting data were compared by chi-square test, and Kaplan-Meier method was used to draw the receiver operating characteristic curve. A P<0.05 was considered statistically significant.Results:The pre-operative average proportion of CD19^(+)CD24^(hi)CD38^(hi) B cells in peripheral blood of ACR group [(3.13±0.91)%] and non-ACR group [(3.49±0.83)%] had no significantly difference (t=1.636, P>0.05). The average proportion of CD19^(+)CD24^(hi)CD38^(hi) B cells in peripheral blood before ACR was (1.87±0.70)% in ACR group. The percentages of CD19^(+)CD24^(hi)CD38^(hi) B cells in non-ACR group were (1.64±0.52)%, (1.63±0.56)% and (2.04±1.24)% respectively at 3, 6 months and 1 year after liver transplantation, and the mean values at 3 and 6 months after liver transplantation were lower than those before surgery and 1 year after liver transplantation (P<0.05). The average proportion of CD19^(+)CD24^(hi)CD38^(hi) B cells in peripheral blood of ACR group was (0.8±0.5)% on the time of

关 键 词：CD19^(+)CD24^(hi)CD38^(hi)B细胞 急性细胞性排斥反应 肝移植 

分 类 号：R657.3[医药卫生—外科学]