肾移植术后可溶性白介素－2受体的动态观察

A STUDY ON SERUM SOLUBLE INTERLEUKIN-2 RECEPTOR LEVEL IN THE DIAGNOSIS OF ACUTE REJECTION IN RENAL TRANSPLANTATION

多年来人们一直在寻找一种非创伤性检查方法来诊断肾移植急性排斥反应。我们采用双抗体夹心ＥＬＩＳＡ分别于术前、术后第３、７天及以后每周１次，连续２个月动态监测２４例肾移植患者１１４例次血清可溶性白介素－２受体（ｓＩＬ－２Ｒ），以探讨其对移植肾急性排斥反应诊断和鉴别诊断的临床意义。结果表明ｓｌＬ－２Ｒ水平移植前高于正常对照组，移植后随着移植肾功能的恢复而明显降低（Ｐ＜０．０１），当发生急性排斥反应时则显著升高，而环孢素肾中毒、急性肾小管坏死时则变化不明显。特别强调了动态检测ｓＩＬ－２Ｒ变化百分率对急性排斥反应的预测、诊断和鉴别诊断具有更重要意义。

A total of 114 samples of serum soluble interleukin -2 receptor levels ( sIL-2R ) were dynamicly mea-sured with enzyme linked immunosorbent assay (ELISA)in 24 patients with renal allografts, Serum slL-2R levels in patients with uremia were evidently higher than those in normal control group and it wasmarkedly reduced after recovery of allograft function. The elevation of serum slL-2R was evident in acuterejection episode and was found as early as 3～8days before elevation of serum creatinine. Patients withcycfosporine nephrotoxicity, acute tubular necrosis and stable renal function without rejection did not haveacomparable rise in sIL-2R. These data show that the level of serum slL-2R is regarded as an importantparameter for the early diagnosis of acute rejection episode. It was noted that preoperation level of serumsIL-2R in uremic patients may foretelI the possible occurrence of acute rejection episode and the prognosisafter renaI transplantation. It was specially emphasized that serial assay with change of sIL-2R level andcomparison of the level with that befOre transplantation are more important than a single serum sll-2R lev-el assay for the early diagnosis and differential diagnosis of acute rejection.