重新评估可溶性白介素2受体检测诊断移植肾急性排异的意义

Re-evaluation of serum and urinary soluble interieukin 2 receptors in diagnosis of acute renal allograft rejection

重新评估血、尿sIL-2R水平变化在肾移植中的临床价值。方法 观察108例同种异体肾移植患者血、尿sIL-2R水平,同时作移植肾活检监测肾组织内IL-2R表达阳性细胞。结果 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。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。结论 (1)血、尿sIL-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结果受术后血尿、尿量、感染和肾功能等许多因素的影响;(2)肾组织内IL-2R的表达水平对急性排异的诊断比较可靠。

To re-evaluation of serum and urinary soluble interleukin 2 receptors (sIL-2R) in diagnosis of acute renal allo-graft rejection. Methods A group of renal transplant patients were observed for serum and urinary sIL-2R level with sandwich enzyme immunoassay. Hie expression of IL-2R in tissue sections of renal graft of these cases biopsied at the same time were also investigated. Results sIL-2R levels in serum and urine were significantly higher in groups with rejection and infection compared with no rejection and controls. IL-2R values measured in all intrarenal samples were found to be consistently higher during rejection than in nonrejection conditions. Conclusion (1) Acute rejection group as a whole (in average) showed a much higher level of both serum and urinary sIL-2R. But single measurement of sIL-2R was influenced by many factors such as urinary output, fever and renal function. It can not be relied for the diagnosis of rejection, unless serial assays were made. (2) Expression of IL-2R in renal tissue is a more reliable marker for acute rejection.