细胞免疫能量测定在肾移植中的应用

Clinical application of immune cell function assay in kidney transplantation

目的 探讨适用于评价肾移植受者免疫状态的新方法.防止移植后的排斥反应和感染,提高人/肾生存质量和存活率.方法 应用ImmuKnow^（TM）-Cylex检测技术测定肾移植受者细胞免疫能量（三磷酸腺苷,ATP）.收集62例肾移植受者术前（术前组）、术后稳定期（术后稳定组）、发生感染（术后感染组）和排斥反应（排斥反应组）等不同时期的肝素钠抗凝样本共150份.通过测量CD4＋T淋巴细胞受刺激后释放的ATP浓度来判定细胞免疫力.并用秩和检验和两两比较统计方法,对结果进行分析和比较.结果 各组肾移植受者CD4＋T淋巴细胞ATP浓度分别为：术前组（281.33±146.46）/μg/L、术后稳定组（310.19±147.12）/μg/L、术后感染组（142.41±118.26）μg/L、排斥反应组（332.77±154.44）μg/L;术后感染组ATP浓度显著低于其他各组.差异均有统计学意义（P〈0.05）.结论 LmmuKnow^（TM）-Cylex细胞免疫能量测定具有灵敏度高、特异性强、简便易操作等优点,适合于肾移植受者免疫状态的临床监测,特别是对术后感染有很好的预警作用,对指导感染后免疫抑制剂的个体化用药具有一定的参考价值.

Objective To investigate a new applicable method for determining immune cell function （ATP value） in kidney transplant recipients measured by the ImmuKnow assay in order to minimize the risk of infection or rejection and improve graft function.Methods 150 heparinized blood samples were taken from 62 kidney recipients before and after transplantation.By using ImmuKnow assay, cell-mediated immunity （CMI） was assessed by measuring the concentration of ATP from CD4＋ cells following stimulation.Rank sum test was used for analysis of data.Results The mean ATP value in the recipients with infection after kidney transplantation was （142.41±118.26） μg/L, significantly lower than that in pretransplant recipients [（281.33±146.46） μg/L], stable recipients [（310.19±147.12） μg/L] and the recipients with rejection [（332.77±154.44） μg/L], P〈0.05.Conclusion With its good qualities of high sensitivity and specificity, ImrnuKnow assay is a valuable tool in monitoring immune status in posttransplant recipients and especially in predicting infectious complications.It can guide therapy decisions to better individualize and adjust immunosuppressant regimens in the treatment of infection.