肾移植受者体内细胞因子及其受体的水平及意义

Significance and levels of cytokines and their receptors in renal transplant recipients

检测了７２例肾移植患者血中可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）、肿瘤坏死因子（ＴＮＦ）及白细胞介素６（ＩＬ－６）的水平。结果发现，正常健康对照组ＳＩＬ－２Ｒ为１２５±５４ｋＵ／Ｌ，术后肾功能平稳组为２５６±９３ｋＵ／Ｌ，环孢素Ａ中毒组为３３８±７３ｋＵ／Ｌ，而ＴＮＦ在这几组中均测不出，ＩＬ－６均小于５ｋＵ／Ｌ。肾移植术后ＳＩＬ－２Ｒ迅速下降，与血肌酐有明显的一致性，ＩＬ－６水平升高，第２天达高峰（１８．２５±２．３６ｋＵ／Ｌ），以后逐渐下降，１０天后降至５ｋＵ／Ｌ。发生急性排斥反应组ＳＩＬ－２Ｒ为１０７７±４４８ｋＵ／Ｌ，升高较血肌酐提早２．２天，敏感性达９４．４％，特异性达９１．７％；ＩＬ－６为５９．９±３５．２７ｋＵ／Ｌ，并较临床症状出现平均提早１．２天；ＴＮＦ为３３．６７±１３．７μｇ／Ｌ，检出率为６７％。感染组的ＳＩＬ－２Ｒ、ＩＬ－６、ＴＮＦ分别为１６２０±３９７ｋＵ／Ｌ、７９．７５±６１ｋＵ／Ｌ及１２７．５±８３．８μｇ／Ｌ。结果表明，ＳＩＬ－２Ｒ、ＴＮＦ、ＩＬ－６可作为监测肾移植排斥反应的指标。

The levels of soluble interlukin- 2 receptor (SIL-2R), tumor necrosis factor (TNF) , and interlukin- 6 (IL-6) were measured in 72 renal allograft recipients.Patients with stable renal function and with CsA nephotoxicity demonstrated increased SIL-2R levels (256±93kU/L, 383±73kU/L VS 125±54kU/L in healthy controls, P<0. 001). TNF plasma levels were undetectable, and IL- 6 serum levels were consistently low (<5kU/L) in these groups. The SIL-2R levels paralleled the SCr which declined after transplantation. The serum IL-6 levels increased rapidly, reaching to the peak levels up to 18. 25±2.36kU/L on the second posttransplant day . then, declined and stabilized at 5 kU/L within ten days. At acute rejection episods, SIL-2 level was significantly higher (1 077±448kU/L, P<0. 001 VS stable) preceded by the increasc of SCr by an average of 2. 2 days. The sensitivity of SIL-2R monitoring was 94. 4% and the specificity was 91. 7%. IL-6 levels also obviously increased to a median value of 59. 9±35. 2 kU/L (P<0. 001) at a mean time of 1. 2 days before the clinical phenomena. Patient with acute rejection has marked increased plasma TNF (33. 67±13. 7μg/L, P<0. 01) . The positive samples were 67%. In patients with infection the levels of SIL-2R. IL-6 and TNF also elevated (1 620±397kU/L, 79. 75±61kU/L and 127. 5±83. 8kU/L). The results suggest that SIL-2R, TNF and IL-6 may be considered as the indicators of acute allograft rejection.