供体骨髓输注肾移植受者外周血嵌合体动态变化及对排斥的影响  

Dynamic variety of chimerism in peripheral mononuclear cells of renal allograft recipients received donor bone marrow cells infusions and relationship between chimerism and acute rejection

作　　者：陈江华[1] 王仁定[1] 吴建永[1] 李敏伟[2] 方廉廉[1] 何强[1] 

机构地区：[1]浙江大学附属第一医院肾脏病中心,杭州310003 [2]浙江大学附属第一医院传染病研究所流式细胞室,杭州310003

出　　处：《中华肾脏病杂志》2003年第6期385-388,共4页Chinese Journal of Nephrology

基　　金：浙江省自然科学基金优秀青年人才基金(N29853)

摘　　要：目的 探讨供体特异性骨髓输注肾移植受者外周血嵌合体动态变化及对急性排斥的影响。方法 自1999年1月至2001年12月本中心对63例尿毒症患者进行了尸体肾脏移植联合供体特异性骨髓细胞(DBMC)输注(骨髓组),同期406例单纯接受肾移植(对照组)。采用原位PCR与流式细胞仪相结合的PCR-Flow方法对36例DBMC输注病例(DBMC组)和26例与DBMC输注配对病例(配对对照组),用PCR-Flow方法进行嵌合体检测。结果 术后4周和8周DBMC组与配对对照组相比,嵌合体明显增加,分别为(9.20±8.03)％比(1.29±2.05)％(P<0.01),和(7.73±7.35)％比(0.76±1.93)%(P<0.01)。但8周以后各个时间点两组之间差异无显著性意义。随访期间,骨髓组和对照组Scr无显著差异,但急性排斥发生率前者明显低于后者,分别为3.17%与12.81％(P<0.05)。结论 DBMC输注能促进术后早期嵌合体的形成,显著降低急性排斥发生率。Objective To explore dynamic variety of chimerism in patients with donor bone marrow cells (DBMC) infusion and the impact on rejection. Methods January 1999 and December 2001, 63 cadaver renal allograft recipients of postoperative donor bone marrow infusion (bone marrow group) were prospectively with 406 controls (control group) given equivalent immunosuppression. Novel technique combining PCR and flow cytometry - PCR-Flow was used,to identify donor derived cell-chimerism in 36 renal allograft recipients with donor bone marrow infusion (DBMC group) and 26 contralateral controls (contralateral group). Results There was a significant increase in detection level of chimerism at 4th week and 8th week postoperatively in DBMC group vs contralateral group,i. e.,(9. 20 ± 8. 03)% vs (1.29 ± 2.05)% (P< 0.01) and (7. 73±7. 35)% vs (0.76±1.93)% (P<0.01),respectively. But no significance was seen between two groups after 8 weeks. The rate of acute rejection in bone marrow group was significantly lower than that in control group,i. e.,3. 17% vs 12. 81% ( P < 0. 05),but no significance was seen in serum creatinine between two groups. Conclusion DBMC infusion can augment chimerism in early postoperative period,and significantly reduce the rate of acute rejection.

关 键 词：供体骨髓输注 肾移植 外周血 嵌合体 动态变化 排斥 

分 类 号：R699[医药卫生—泌尿科学]