外周血CD4^+CD25^(high)调节性T细胞比例变化在肾移植受者移植后免疫监测中的应用

Application of peripheral CD4^+CD25^(high) infused regulatory T cells proportional change in immune monitoring of recipients after renal transplantation

背景:相关实验表明调节性T细胞在移植物免疫耐受中起重要作用。目的:观察外周血CD4+CD25high调节性T细胞比例变化与肾移植受者移植后免疫变化的相关性。设计、时间及地点:回顾性病例分析,于2007-09/2008-07在广东省第二人民医院器官移植中心及其实验室完成。参试者:52例病情稳定的维持性血液透析患者行同种异体肾移植治疗。方法:肾移植后患者均服用三联免疫抑制剂。所有患者移植后发生急性移植肾排斥反应以及感染均按照相应指南诊断及治疗。分别于移植前和移植后1,2,4,8,12周以及发生排斥反应和感染时抽血检测外周血CD4+CD25+调节性T细胞。按其免疫力恢复情况分为正常组26例,排斥反应组17例,感染组9例。主要观察指标:用流式细胞仪检测外周血CD4+CD25high调节性T细胞的比例,所得结果进行相关分析。结果:与正常组比较:排斥反应组CD4+CD25highFoxP3/CD4+的比值降低(P<0.05),而感染组显著增高(P<0.01)。与感染组比较:排斥反应组CD4+CD25highFoxP3/CD4+的比值显著降低(P<0.01)。结论:肾移植后受者外周血CD4+CD25high调节性T细胞比例与受者免疫状态密切相关。CD4+CD25high调节性T细胞比例的变化可以反应机体的免疫状态的变化,其升高或降低可以作为预测肾移植受者移植后发生感染或排斥反应的指标之一。

BACKGROUND： Relative experiments have shown that regulatory T cells play an important role in graft tolerance. OBJECTIVE： To observe the correlation of the proportion change of peripheral CD4^＋CD25^high infused regulatory T cells and the change of immune status in recipients after renal transplantation. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at the Center of Organ Transplantation and its Laboratory of Guangdong No.2 Provincial People＇s Hospital from September 2007 to July 2008. PARTICIPANTS： A total of 52 patients with maintaining hemodialysis who were in stabilized condition were selected in the experiment. All patients were received allograft renal transplantation. METHODS： All patients took triple immunosuppressant after renal transplantation. Patients with acute rejection and infection were diagnosed and treated in accordance with the corresponding guidelines. CD4^＋CD25^high infused regulatory T cell were detected before and 1,2, 4, 8, 12 weeks after transplantation, as well as the occurrence of rejection and peripheral blood infection According to the recovery, patients were divided into normal group （n=26）, immune rejection group （n=17） and infection group （n=9）. MAIN OUTCOME MEASURES： The proportions of peripheral CD4^＋CD25^high infused regulatory T cells were detected by using flow cytometry, and the correlation analysis of results was performed. RESULTS： Compared with normal group, the ratio of CD4^＋CD25^highFoxP3/CD4^＋ significantly decreased in immune rejection group （P 〈 0.05）, and significantly increased in infection group （P 〈 0.01）. Compared with infection group, the ratio of CD4^＋CD25^highFoxP3/CD4^＋ significantly decreased in immune rejection group （P 〈 0.01）. CONCLUSION： After renal transplantation, the proportion of CD4^＋CD25^high regulatory T cells is closely related to the recipient immune status. The proportion change of CD4^＋CD25^high regulatory T cells can reflex the immune status, and increase or decrease of it in renal transplant recipients can be as an index for forecasting occurrence of infection or rejection after transplantation.