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目的分析并监测肾移植术后早期急性排斥反应(AR)患者淋巴细胞亚群比例,供者特异性抗体(DSA)及非供者特异性抗体(NDSA)水平,为临床预防排斥反应的发生、早期诊断排斥反应,以及制定合理的个体化免疫抑制治疗方案、评估治疗效果提供可靠依据。方法选择2014年1月至2016年6月肾脏移植受者454例,采用流式细胞计术及Luminex技术对肾脏移植受者术后淋巴细胞比例、DSA及NDSA进行动态监测,应用SPSS 17.0软件进行统计学分析。结果 454例受者中,33例术后6个月内发生AR(AR组),421例肾功能稳定(SF组)。肾脏移植受者AR发生时,外周血CD4+T/CD8+T比值(2.81±0.85 vs 1.39±0.94,t=7.336,P<0.001)及B细胞百分比[(15.79±3.53)%vs(10.2±3.04)%,t=4.986,P<0.001]显著高于SF组。HLA抗体中位荧光强度(MFI)的监测发现,AR患者在移植术后1周左右HLA抗体水平逐渐升高,与SF组MFI相比,差异有统计学意义(P<0.05)。AR患者排斥反应发生时抗体MFI值为7 559±1 496,治疗后为3 023±996,差异有统计学意义(t=13.853,P<0.001)。DSA-/NDSA-患者AR发生率为3.1%(11/357);DSA-/NDSA+患者AR发生率为14.5%(12/83);DSA+/NDSA+患者AR发生率为71.4%(10/14),与前两者相比差异有统计学意义(P<0.001)。结论肾脏移植术后早期监测CD4+T/CD8+T比值及B淋巴细胞百分比的变化及血清DSA/NDSA水平对于AR诊断和预警具有一定的指导价值。
Objective To analyze and monitor the levels of lymphocyte subsets, donor-specific antibodies (DSA) and non-donor specific antibodies (NDSA) in patients with early acute rejection after renal transplantation for the prevention of rejection. Early diagnosis of rejection, as well as to develop a reasonable individualized immunosuppressive treatment programs to assess the efficacy of treatment to provide a reliable basis. Methods 454 renal transplant recipients from January 2014 to June 2016 were selected. The lymphocyte proportion, DSA and NDSA were measured dynamically by flow cytometry and Luminex technique. The data were analyzed by SPSS 17.0 software Statistical analysis. Results Among the 454 recipients, AR occurred in 33 cases (AR group) and stable renal function (SF group) in 421 cases within 6 months after operation. The ratio of CD4 + T / CD8 + T (2.81 ± 0.85 vs 1.39 ± 0.94, t = 7.336, P <0.001) and the percentages of B cells in renal transplant recipients AR [(15.79 ± 3.53)% vs 3.04)%, t = 4.986, P <0.001] was significantly higher than the SF group. The detection of HLA antibody (MFI) showed that the level of HLA antibody in AR patients gradually increased at 1 week after transplantation, which was significantly different from that in SF group (P <0.05). Antibody MFI was 7 559 ± 1 496 in AR patients and 3 023 ± 996 after treatment, the difference was statistically significant (t = 13.853, P <0.001). The incidence of AR was 3.1% (11/357) in DSA- / NDSA-patients, AR was 14.5% (12/83) in DSA- / NDSA + patients and AR was 71.4% (10/14) in DSA + / NDSA- , Compared with the former two difference was statistically significant (P <0.001). Conclusion The early monitoring of CD4 + T / CD8 + T ratio and the percentage of B lymphocytes and the level of serum DSA / NDSA after renal transplantation may be of guiding value in the diagnosis and early warning of AR.