可溶性白介素2受体诊断急性排异的再评价

Re-evaluation of serum and urinary soluble interleukin 2 receptors(sIL-2R)in diagnosis of acute renal allograft rejection

本文对76例同种异体肾移植患者血、尿 sIL-2R 水平进行观察,同时作移植肾活检监测肾组织内 IL-2R 表达阳性细胞,重新评估血、尿 sIL-2R 水平变化在肾移植中的临床价值。结果表明:急性排异组血、尿 sIL-2R 水平均明显高于无排异组、ATN 组和 CsA 肾中毒组,但急性排异组与感染组之间并无显著性差异,临床上仍难以鉴别。发现急性排异组肾组织内 IL-2R 表达明显高于无排异组、ATN 组、CsA 肾中毒组和感染组。作者认为血、尿 slL-2R 群体水平的变化对急性排异具有诊断价值。但是,单次测定血、尿 sIL-2R 结果受尿量、感染和肾功能等许多因素的影响。肾组织内 IL-2R 的表达水平对急性排异的诊断和鉴别诊断相对比较可靠。

Background sIL-2R levels had been rec- ommended for the differential diagnosis of acute renal allograft rejection.To re-evalu- ate the diagnostic utility of this test,a group of renal transplant patients were observed for serum and urinary sIL-2R level with sandwich enzyme immunoassay.The expres- sion of IL-2R in tissue sections of renal graft of these cases biopsied at the same time were also investigated. Experimental design The clinical situation of the patients were classified into 5 groups according to the histological and clinical ob- servation:No rejection(n=37),acute re- jection(AR,n=12),acute tubular necrosis (ATN,n=4),infection(n=15)and CsA toxicity(n=8). Results The concentration of serum sIL- 2R in 33 pretransplant patients was elevated compared with controls,but fell after trnas- plantation in 25 of these patients.The urine sIL-2R concentration rose in the immediate posttransplant period.sIL-2R levels in serum and urine were significantly higher in groups with rejection and infection com- pared with no rejection and controls.Ten patients were studied sequentially around the time of acute rejection.Serum levels of sIL-2R began to rise 1 day before clinical re- jection.In this study,the IL-2R values mea- sured in all intrarenal samples were found to be consistently higher during rejection than in nonrejection conditions. Conclusion ①Acute rejection group as a whole(in average)showed a much higher level of both urinary and serum sIL-2R as compared with those cases without rejec- tion,acute tubular necrosis or CsA toxicity. Patients with infection also had significant elevation of sIL-2R levels very similar to that of acute rejection cases.②Single mea- surement of sIL-2R was influenced by many factors such as urinary output,fever and re- nal function.It can not be relied for the di- agnosis of rejection,unless serial assays were made.③Expression of IL-2R in renal tissue is a more reliable marker for acute re- jection.