小柴胡冲剂对耐激素型排斥反应的治疗作用

Therapeutic Effect of Minor Radix Buplenri Granule on Steroid-Resistant Acute Rejection

目的探讨中药制剂小柴胡冲剂对肾移植术后耐激素性急性排斥反应的治疗作用及其机制。方法应用放射配体结合分析法测定38例肾移植术后发生急性排斥反应(AR)者外周血淋巴细胞糖皮质激素受体(GR)位点的变化,以GR位点数量将其分为低GR位点组(16例,GR<800,)和高GR位点组(22例,GR≥800)两组,观察甲基强地松龙(MP)及MP加小柴胡冲剂对AR的疗效及对GR表达的影响。结果AR组GR位点数明显高于肾功能稳定组(P<0.01),其中16例GR低表达者的GR位点数明显低于肾功能稳定组(P<0.05)。GR高表达组多数对MP治疗反应好,治疗后GR位点明显降低(P<0.01),8例GR低表达者单纯MP冲击治疗,7例效差,治疗后GR位点无明显变化(P>0.05),而8例MP加小柴胡冲剂治疗者6例效果较好,治疗后GR位点明显升高(P<0.05),MP+小柴胡冲剂治疗组GR mRNA表达较单纯MP治疗组及治疗前有明显升高(P<0.01)。结论监测外周血淋巴细胞GR表达可以预测AR对激素治疗的敏感性,辅助应用小柴胡冲剂可提高GR的表达,逆转AR的激素抵抗性。

Objective To study the effect and mechanism of Minor Radix Buplenri granule on steroid - resistant acute rejection （SRAR） after renal transplantation. Methods Radioligand bind assay was used to determine glucocorticoid receptor （GR） binding site of peripheral blood lymphocytes in 38 cases of patients with SRAR after renal transplantation, and then these patients were divided into low and high GR situs groups （ GR situs 〈 800 and ≥ 800 respectively）, the effects of methylpred- nisolone （MP） and MP ＋ Minor Radix Buplenri granule on SRAR and GR expression were investigated. Results GR situs in AR group were higher significantly than that in the group with stable graft functions and low GR situs group were lower significantly than that of stable graft functions group. Most of those with high GR situs had a good therapeutic reaction to MP and GR situs decreased, 7 of 8 cases of low GR situs had a bad therapeutic reaction to MP and GR situs had no obvious change （ P 〉 0.05 ）, meanwhile, 6 cases presented a good therapeutic effect in 8 cases treated with MP ＋ Minor Radix Buplenri granule and GR situs and GR mRNA expression increased significantly （ P 〈 0.01 ）. Conclusion Monitoring GR expression in peripheral blood lymphocytes can prognose the therapeutic reaction of AR to GC therapy, Minor Radix Buplenri granule may increase GR expression and reverse the steroid - resistantance of SRAR.