循环内皮细胞检测在移植肾血管性排斥反应诊断中的应用

Peripheral blood circulating endothelial cell and acute vascular rejection in renal allograft patients

目的:分析外周血循环内皮细胞(CECs)与移植肾急性排斥反应(AR)的关系及对预后判断的意义。方法:2006年11月至2007年12月在我院行移植肾活检患者42例。依肾活检病理改变,将患者分为移植肾正常改变组(组I)和AR组(组II),组II再分为急性血管性排斥组(组II-A)、急性混合性排斥组(组II-B)和急性间质小管性排斥组(组II-C)。患者在移植肾活检前2d抽外周血,采用免疫磁珠分离方法检测CECs并计数。结果:组II(n=25)CECs计数高于组I(n=17)(27.0±13.6vs14.6±4.2,P<0.01)。组II-A(n=5)CECs计数高于组II-C组(n=13)(38.6±6.8vs19.5±9.5,P<0.01),组II-B(n=7)CECs计数高于组II-C(32.6±15.9vs19.5±9.5,P<0.01),而组II-A和组II-B之间CECs计数差异无统计学意义(P>0.05);组II-C的CECs计数虽然高于组I,但两者之间差异无统计学意义(P>0.05)。CECs计数升高(CECs≥24 cells/ml)组动脉内膜炎发生率较高(P<0.01)。组II中CECs升高者耐激素比例高(P<0.05),1年后移植肾存活率低(P<0.01)。II-A组经治疗后CECs计数随着移植肾功能改善下降(P<0.01)。结论:肾移植受者CECs计数可作为判断排斥反应中血管病变及治疗反应的重要指标。

Objective ： To investigate the value of peripheral blood circulating endothelial cells （CECs） on the diagnosis and the short-term outcome of acute rejection （AR） in patients with renal allograft. Methodology：Total fourty two renal transplant patients received renal allograft biopsy from Nov. 2006 to Dec. 2007 were investigated in this study. They were divided into two groups： group Ⅰ （normal group,n = 17） and group Ⅱ （AR group, n =25）. Then the group Ⅱ was separated into group Ⅱ-A （ acute vascular rejection group, n = 5 ）, group Ⅱ-B （ mixed rejection group, n = 7 ） and group II-C （acute tubulointerstitial rejection group,n = 13 ）. The CECs were isolated from peripheral blood and were counted by microscopy during the renal biopsy time. Results：The count of CECs was higher in group Ⅱ than that in group Ⅰ （27.0 ± 13.6 vs ld. 6 ± 4. 20, P 〈 0. 01 ）, in group Ⅱ-A higher than that in group II-C （ 32.6 ± 15.9 vs 19. 5 ± 9. 50, P 〈 0. 01 ） and no significant difference between group Ⅱ-A and group Ⅱ-B （ P 〉 0. 05 ）. The count of CECs in group Ⅱ-C was higher than group Ⅰ with no significant difference （ P 〉 0. 05 ）. The increasing count of CECs （ CECs t〉 24 cells/ml ） was related to endarteritis （P 〈 0. 01 ）. The steroid resistant rate of high CECs count was higher than that of low CECs count（ CECs 〈 24 cells/ml）in group Ⅱ （9/14 vs 3/11 ,P 〈0. 05）. The one year graft survival of patients with high CECs count was worse than that with low CECs count （P 〈 0. 05）. The count of CECs was decreased significantly with the recovery of renal allograft function in group Ⅱ-A （P 〈 0.01 ）. Conclusion：The count of CECs in peripheral blood was related to the AR, and also related to the endarteritis in renal allograft. It might be used as a differential diagnosis marker for the AR and a marker for the prognosis of AR.