肾移植急性排斥反应时尿中供体细胞DNA检测的临床意义(英文)  

PCR and PCR-SSP for detection of urinary donor-origin DNA in renal transplant recipient with acute rejection

作　　者：张志宏[1] 付耀文[2] 韩文科[1] 许昕[1] 历将斌[1] 李彦峰[1] 郭应禄[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京100034 [2]吉林大学中日联谊医院泌尿外科,吉林长春130000

出　　处：《中国现代医学杂志》2004年第2期1-6,12,共7页China Journal of Modern Medicine

基　　金：ThisworkwassupportedbygrandsfromNationalPostdocteralProgransFoundationandNationalNaturalScienceFoundationofChina(No .3 0 2 712 96)

摘　　要：目的　通过对肾移植患者急性排斥反应时尿中出现的供体细胞的DNA进行检测 ,试图找到一种方便快速、无创性诊断肾移植急性排斥反应的新方法。方法　以供体为男性 ,受体为女性或HLA -DR抗原有错配的肾移植患者 80例为研究对象 ,其中急性排斥反应 34例 ,肾功能正常者 4 1例 ,药物性肾功能损伤 5例。利用PCR及PCR -SSP法分别检测Y染色体上特异的基因片断SRY、DYZ - 1和HLA -DR抗原的基因片断DRBl。结果　供体为男性的女性急性排斥反应患者 11例 ,SRY阳性 10例 (90 .9% ) ,DYZ - 1阳性 11例(10 0 % ) ;对照组肾功能正常患者 14例 ,SRY的检测结果为阳性 1例 ,阴性 13例 (92 .8% ) ;DYZ - 1阳性 2例 ,阴性 12例 (85 .7% )。HLA -DR抗原有错配的急性排斥反应 2 3例 ,DRBl阳性 2 1例 (91.3% ) ,阴性 2例 ,经抗排斥治疗 17例转为阴性 ;对照组肾功能正常患者 2 7例 ,DRBI阳性 3例 ,阴性 2 4例 (88.9% )。药物性肾功能损伤 5例的PCR检测结果均为阴性。结论　肾移植术后急性排斥反应发生时 ,患者尿中来自供体细胞的DNA高频率地出现 ,随着抗排斥治疗移植肾功能恢复而消失。同时 ,肾功能正常及药物性肾功能损伤患者供体细胞的DNA检测为阴性 。Objective: The purpose of this study was to establish a method for accurate diagnosis of acute rejection by donor specific DNA analysis of urine.Methods: DNAs of 34 patients with episode of acute rejection and 5 patients with drug-induced renal dysfunctions were examined. 41 patients without any trouble after renal transplantation were acted as the controll. DNA extracted from urines was performed with PCRs to examine Y-chromosome (SRY and DYZ-1) in female patients and HLA-DR mismatched grafts. Results: Female recipients from male donors: SRY and DYZ-1 on Y-chromosome of urine were positive in 1 of 14 patients with stable renal functions. On the other hand, SRY and DYZ-1 were all positive in 4 patients with acute rejection, in which 1 became negative and 3 remained positive 3～6 months after discharge. Recipients from HLA mismatched donors: DRB1 was positive in 3 of 27 patients with stable renal functions. At the same time, it was positive in 21 of 23 patients with acute rejection, in which 17 became negative and 2 remained positive at the time of discharge.Conclusion: The appearance of donor DNA in urine is strongly associated with acute rejection. Therefore, analysis of urinary DNA from donor origin was effective and accurate for diagnosis of acute rejection in the renal transplantation.

关 键 词：急性排斥反应 肾移植 PCR 尿 DNA 

分 类 号：R699.2[医药卫生—泌尿科学]