抗Tac单抗诱导治疗对肾移植受者外周血淋巴细胞CD分子表达的影响

Effect of anti-Tac monoclonal antibody on expression of CD molecules in peripheral lymphocytes of cadaveric kidney transplantation recipients

目的:探讨首次尸肾移植受者使用抗Tac单抗诱导治疗后外周血淋巴细胞CD分子的动态变化及其临床意义.方法:对首次尸肾移植的患者,在三联免疫抑制方案(激素+骁悉+新山的明)基础上,给予两剂抗Tac单抗诱导治疗,其中舒莱组30例,赛呢哌组28例.以流式细胞仪检测术前,术后第1天、1周、2周、4周、6周及8周外周血淋巴细胞CD分子的表达.结果:移植受者外周血淋巴细胞CD分子变化明显,其中CD25在术后明显下降(P＜0.05),并维持4～6周;CD40亦明显下降(P＜0.05),术后2周时开始回升;CD86、CD28、CD80、CD95等均有下降,但各组间差异无统计学意义.舒莱组和赛呢哌组CD分子表达差异亦无统计学意义.结论:抗Tac单抗可以有效地封闭外周血活化淋巴细胞表面的CD25,抑制其增殖和分化;通过某种机制,抗Tac单抗可以降低外周血淋巴细胞CD40的表达,可能起到抑制B淋巴细胞活化的作用.

Objective:To sequentially observe the CD molecule expression on the surface of peripheral lymphocyte in the primary cadaveric renal transplantation recipients treated with the induction therapy of anti-Tac monoclonal antibody, explore the molecular mechanism in relation to its immunological role.Methods:All the 58 patients were randomly divided into Simulect group (n=30) and Zenapax group (n=28), treated with the same triple-drug baseline immunosuppression (Cyclosporine microemulsion [Neoral], mycophenolate mofetil , and corticosteroid) and different induction therapy (2 doses of 20mg Simulect on day 0 and day 4, 2 doses of 50mg Zenapax on day 0 and day 14, respectively). Flow cytometer was used to count the number of lymphocytes expressing the different CD molecules. The times of assessment were day 0 (before transplantation), day 1, week 1, week 2, week 4, week 6, week 8 posttransplantation.Results:The expressions of CD molecules in the peripheral lymphocytes display dramatic fluctuation during the research. CD25 decreased significantly (P<(0.05)), and sustained until 6-8 weeks posttransplantation. CD40 also decreased obviously (P<(0.05)), with the lowest point at week 1 posttransplantation. The other molecules CD86, CD28, CD80, CD95 decreased with no significance (P>(0.05)), compared with pretransplantation. And the difference between the two groups can be neglected (P>(0.05)).Conclusions:Targeting at the CD25 molecule, the anti-Tac monoclonal antibody effectively inhibits the IL-2 pathway during the T cell proliferation and differentiation in the cadaveric renal transplantation. Through certain mechanism, anti-CD25 monoclonal antibody can decrease the expression of the CD40 on the surface of peripheral lymphocytes, maybe do some effect on the activation of B lymphocytes during the allograft transplantation.