T淋巴细胞亚群检测在肾移植排斥反应与环孢霉素A中毒鉴别诊断中的应用

Application of T-lymphocyte subsets detection for the differential diagnosis between acute rejection and cyclosporine A toxicities after renal transplantation

目的探讨外周血淋巴细胞亚群检测在人类同种异体肾移植术后急性排斥反应与免疫抑制剂环孢霉素A(cy-closporine A,CSA)中毒的诊断与鉴别诊断中的价值。方法采用四色流式细胞技术对26例肾移植术后肾功能正常、11例急性排斥反应、10例环孢霉素A中毒患者外周血淋巴细胞亚群中CD3+、CD3+CD4+、CD3+CD8+细胞的百分比进行检测。结果肾功能正常组、急性排斥反应组与环孢霉素A中毒组外周血淋巴细胞中CD3+细胞的百分比分别为71.83%±9.65%、73.29%±8.85%、72.06%±12.04%,3组比较差异无统计学意义;CD3+CD4+细胞的百分比分别为38.69%±9.21%、49.58%±8.41%、40.15%±9.98%,急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义(P<0.01);CD3+CD8+细胞百分比分别为29.28%±9.02%、19.18%±5.35%、30.86%±9.19%,急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义(P<0.01);CD3+CD4+/CD3+CD8+分别为1.76±0.97、2.92±0.71、1.81±0.92,急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义(P<0.01)。结论检测外周血淋巴细胞亚群的变化,对肾移植术后急性排斥反应和环孢霉素A中毒有鉴别诊断的价值。

Objective To study the value of peripheral blood lymphocyte subsets analysis in the diagnosis of acute rejection and CSA toxicities in human renal transplantation. Methods Peripheral blood from 47 patients transplanted with planted cadaver kidney （stable renal function 26, acute rejection 11, CSA toxicities 10） were studied for analysis the percentage of CD3^＋, CD3^＋ CD4^＋, CD3^＋CD8^＋ cells by using four-color flow cytometry, and the ratio of CD3^＋CD4^＋/CD3^＋CD8^＋ was calculated. The results were analyzed with q test. Results The percentages of CD3^＋ cell in stable group, acute rejection group and CSA toxicities group were 71.83 % ±10.96 % ,73.29 %± 8.85 % ,72.06 % ± 12.04 % respectively. There were no percentage differences of CD3^＋ cell among 3 groups. The percentages of CD3^＋,CD4^＋ cells in 3 groups were 38.69 % ±9.21%,49.58 %± 8.41%,40.15 % ± 9.98 % respectively. The percentages of CD3^＋,CD8^＋ cells in 3 groups were 29.28 %± 9.02 %, 19.18 % ± 5.35 % ,30.86 % ±9.19 % respectively. The percentages of CD3^＋,CD4^＋/CD3^＋,CD8^＋ cells in 3 groups were 1.76 ±0.97,2.92 ± 0.71,1.81± 0.92 respectively. The statistical significant difference （P 〈 0.01 ） was found. Conclusion There is significant differential diagnostic value in the analysis of peripheral blood lymphocyte subsets between the acute rejection and CSA toxicities in human recipients of renal transplantation.