外周血免疫效应分子基因表达与移植物急性排斥的关系

Correlation between Gene Expression of Immune Effector Molecule and Acute Rejection in Renal Transplantation

目的 探讨5种免疫效应分子基因的表达与移植肾急性排斥的关系.方法 采用定量逆转录PCR（RT-PCR）方法动态测定急性排斥反应（AR） 组（n=22）、阴性对照组（n=22）肾移植患者移植外周淋巴细胞（PBL）的颗粒酶B、穿孔素、Fas、FasL和TIA-1的含量,判断其与急性排斥的关系.结果 肾移植术后出现急性排斥的患者各效应分子表达均明显增强,在排异初期与后期有明显的下降（P〈0.05）;各效应分子升高时间比临床上出现AR的症状早约2d,随着AR的逆转,其表达也逐渐降至原有基础水平.AR组与对照组在多个基因表达的联合分析可不同程度地提高敏感性和特异性,3种基因同时上调尤其有意义.结论 定量逆转录PCR（RT-PCR）方法测定外周血免疫效应分子基因的表达,是一种无创、较敏感的早期诊断肾移植急性排斥的方法,并可预测抗排斥反应治疗效果.

Objective To explore the relationship between gene expression of five kinds of immune effector molecule and acute rejection （ AR ） of renal transplantation. Methods The method of quantitative reverse transcriptase PCR （ RT-PCR ） was used to dynamically detect the level of peripheral lymphocytes （ PBL ） of granzyme B, perforin, Fas, FasL,and TIA-1 in patients with （ n = 22 ） and without （ n = 22 ） AR after renal transplantation. Results The level of each immune effector molecule was increased obviously after renal transplantation and reduced in initial and later stage in patients with acute rejection （ P 〈 0.05 ）. The occurrence of the increase of effector molecule was two days earlier than that of appearance of clinical symptoms of AR. With the improvement of AR, the expression level of effector molecule gradually came to the original level. Unite analysis of several kinds of gene expression between AR and the control group can improve the sensitivity and specificity to some degree. It makes sense that three genes were up-regulated at the same time. Conclusion Detecting gene expression of immune effector molecule in peripheral blood using quantitative RT-PCR is a non-invasive and more sensitive method for early diagnosis of acute rejection in kidney transplantation. It can predict response to anti-rejection treatment.