乌司他丁对肾移植患者围手术期外周血T细胞亚群CD95表达以及血浆sICAM-1、IL-8水平的影响

Effects of ulinastatin on peripheral blood T cell subsets CD95 expression and plasma sICAM-1,IL-8 levels during perioperative renal transplantation

目的观察乌司他丁对肾移植患者围手术期外周血T细胞亚群CD95表达及外周血细胞因子可溶性细胞间黏附分子1（sICAM-1）、白细胞介素8（IL-8）水平的影响,探讨其促进移植肾功能早期恢复的机制及对患者机体免疫功能的调节作用。方法择期肾移植患者51例,ASAⅡ~Ⅲ级,随机分成乌司他丁干预组（n=26）和对照组（n=25）。观察两组麻醉给药前,术后第7、14天外周血T细胞亚群CD95表达水平及外周血细胞因子水平的变化。结果两组患者肾移植术后第7、14天外周血T细胞亚群CD95表达水平及外周血细胞因子sICAM-1、IL-8水平较麻醉给药前前显著升高（P〈0.01）,在第7天时点最高,在第14天时点仍显著高于血管开放前水平（P〈0.05）;但乌司他丁组升高的幅度在第7、14天时点均对照组组小（P〈0.05）。结论肾移植患者围手术期外周血T细胞亚群CD95表达水平增高,CD95表达增加是肾移植患者免疫系统亢进的表现,乌司他丁能有效减少肾移植围术期CD95的表达,能够保护和恢复肾移植术后患者的细胞免疫功能。肾移植围术期血中促炎因子sICAM-1、IL-8水平显著增高,可能与肾缺血再灌注损伤有关。乌司他丁能有效减少肾移植围术期ICAM-1、IL-8的释放,对缺血再灌注损伤后的移植肾有保护作用。

Objective To analyse the effects of ulinastatin on peripheral blood T cell subsets CD95 expression and plasma sICAM-1,IL-8 levels during perioperative renal transplantation,and explore the mechanism of ulinastatin improving postoperative kidney function and regulation of immune function.Methods Fifty-one patients（ASA Ⅱ-Ⅲ） received selective renal transplantation were randomly divided into two groups： ulinastatin group（n=26） and control group（n=25）.Blood samples were taken from central vein before anesthesia,on the 7th day and 14th day after operation for determination of peripheral blood T cell subsets CD95 expression and plasma sICAM-1,IL-8 levels.Results The peripheral blood T cell subsets CD95 expression and plasma sICAM-1,IL-8 levels significantly increased on the 7th and 14th day after operation than baseline value（P0.01）.The peak appeared on the 7th day after operation,but on the 14th day after operation,the CD95 expression levels and serum sICAM-1,IL-8 levels still higher than baseline（P0.05）.The increasing amplitude of CD95 expression level and plasma sICAM-1,IL-8 levels in ulinastatin group was lower than control group（P0.05）.Conclusion Ulinastatin may effectively reduce the expression of CD95 during perioperative renal transplantation,and restore patient＇s cell immunity function;furthermore,ulinastatin effectively reduce serum levels of sICAM-1 and IL-8,which may have protective effects on renal ischemia reperfusion injury during renal transplantation.