不同类型排斥反应受者血常规及外周血淋巴细胞亚群特征性变化  

Characteristic changes in blood routine and peripheral blood lymphocyte subpopulations in recipients of different types of rejection

作　　者：罗帅宇 聂曼华[1,2] 宋磊[1,2] 谢益欣 钟明达 谭书波 安荣 李潘 谭亮[1,2] 谢续标[1,2] LUO Shuaiyu;NIE Manhua;SONG Lei;XIE Yixin;ZHONG Mingda;TAN Shubo;AN Rong;LI Pan;TAN Liang;XIE Xubiao(Department of Kidney Transplantation,Second Xiangya Hospital,Central South University,Changsha 410011;Clinical Research Center for Organ Transplantation in Hunan Province,Second Xiangya Hospital,Central South University,Changsha 410011;Department of Urology,Institute of Urology Transplantation,Second Hospital,University of South China,Hengyang Hunan 421001,China)

机构地区：[1]中南大学湘雅二医院肾脏移植科,长沙410011 [2]中南大学湘雅二医院湖南省器官移植临床医学研究中心,长沙410011 [3]南华大学附属第二医院泌尿外科,泌尿移植研究所,湖南衡阳421001

出　　处：《中南大学学报（医学版）》2024年第3期417-425,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(82070774,82370760);湖南省自然科学基金(2021JJ40864,2024JJ2088)。

摘　　要：目的:排斥反应一直是限制移植肾存活的最重要因素。移植肾病理活检是排斥反应诊断的金标准,但因其局限性并不能作为常规监测手段。近来,外周血淋巴细胞亚群检测已成为评估机体免疫系统的重要手段,然而其在肾移植领域的应用价值和策略有待探究;此外,常规检验参数的新开发利用也是探索肾移植疾病诊断策略和预测模型的重要手段。本研究旨在结合血常规,探究外周血淋巴细胞亚群与T细胞介导的排斥反应(T cell-mediated rejection,TCMR)和抗体介导的排斥反应(antibody-mediated rejection,ABMR)的相关性及其协助诊断价值。方法:回顾性分析2021年1至12月就诊于中南大学湘雅二医院且符合纳入标准的154例肾移植受者的基本资料以及临床资料。根据排斥反应是否发生及其类型分为稳定组、TCMR组和ABMR组。比较3组的基本资料,并将TCMR组和ABMR组排斥反应治疗前的移植肾功能、血常规和外周血淋巴细胞亚群数据与稳定组进行比较。结果:稳定组、TCMR组和ABMR组在免疫抑制维持方案、移植肾来源等方面差异均无统计学意义(均P>0.05),但ABMR组的肾移植术后时间显著长于稳定组(P<0.001)和TCMR组(P<0.05)。在移植肾功能方面,ABMR组的血肌酐值均高于稳定组和TCMR组(均P<0.01),并且TCMR组也高于稳定组(P<0.01);TCMR组和ABMR组的尿素氮均显著高于稳定组(均P<0.01),而TCMR组和ABMR组之间差异无统计学意义(P>0.05);TCMR组和ABMR组的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)均低于稳定组(均P<0.01)。在血常规方面:ABMR组的血红蛋白、红细胞数和血小板数均低于稳定组(均P<0.05);TCMR组的中性粒细胞比例和数量均高于稳定组(均P<0.05),ABMR组的中性粒细胞比例高于稳定组(P<0.05);TCMR组的嗜酸性粒细胞比例和数量均低于稳定组和ABMR组(均P<0.05);TCMR组和ABMR组的嗜碱性粒细胞比例和数量、淋巴细胞比例和数Objective:Rejection remains the most important factor limiting the survival of transplanted kidneys.Although a pathological biopsy of the transplanted kidney is the gold standard for diagnosing rejection,its limitations prevent it from being used as a routine monitoring method.Recently,peripheral blood lymphocyte subpopulation testing has become an important means of assessing the body’s immune system,however,its application value and strategy in the field of kidney transplantation need further exploration.Additionally,the development and utilization of routine test parameters are also important methods for exploring diagnostic strategies and predictive models for kidney transplant diseases.This study aims to explore the correlation between peripheral blood lymphocyte subpopulations and T cell-mediated rejection(TCMR)and antibody-mediated rejection(ABMR),as well as their diagnostic value,in conjunction with routine blood tests.Methods:A total of 154 kidney transplant recipients,who met the inclusion and exclusion criteria and were treated at the Second Xiangya Hospital of Central South University from January to December,2021,were selected as the study subjects.They were assigned into a stable group,a TCMR group,and an ABMR group,based on the occurrence and type of rejection.The basic and clinical data of these recipients were retrospectively analyzed and compared among the 3 groups.The transplant kidney function,routine blood tests,and peripheral blood lymphocyte subpopulation data of the TCMR group and the ABMR group before rejection treatment were compared with those of the stable group.Results:The stable,TCMR group,and ABMR group showed no statistically significant differences in immunosuppressive maintenance regimens or sources of transplanted kidneys(all P>0.05).However,the post-transplant duration was significantly longer in the ABMR group compared with the stable group(P<0.001)and the TCMR group(P<0.05).Regarding kidney function,serum creatinine levels in the ABMR group were higher than in the stable gr

关 键 词：肾移植 抗体介导的排斥反应 T细胞介导的排斥反应 血常规 外周血淋巴细胞亚群 

分 类 号：R73[医药卫生—肿瘤]