尿HLA-DR在肾移植急性排斥中的检测及其临床意义

Clinical utility of monitoring HLA-DR antigen for the diagnosis of acute rejection after renal transplantation

目的探讨流式细胞术检测尿淋巴细胞人类白细胞抗原(HLA-DR)对移植肾急性排斥反应的诊断价值。方法 36例肾移植患者按照移植肾功能正常、术后急性排斥反应、其他原因引起移植肾功不全等标准分为A^C组,另选取10例健康志愿者作为对照(D组),采用流式细胞术检测尿中HLA-DR阳性细胞表达率。结果与A、C、D组相比,尿淋巴细胞HLA-DR在排斥反应时表达明显增加(P<0.01),抗排斥治疗后逐渐下降。与D组相比,A组和C组HLA-DR表达率轻度升高(P<0.05),但两组间差异无统计学意义(P>0.05)。结论流式细胞术动态检测尿液中HLA-DR阳性率,能准确反映肾移植术后患者的免疫状态,可作为急性排斥反应的特异标志。

Objective To investigate the diagnostic value of the detection of HI.A-DR antigen by flow cytometry（FCM） for the diagnosis of acute rejection after renal transplantation. Methods 36 recipients of renal transplantation were enrolled and divided in to 3 groups,including group A with normal renal function,group B with acute rejection and group C with elevated serum creatinmc but without rejection. 10 cases of healthy individuals were enrolled as controls（group D）. Urinary samples, collected from all subjects,were detected for the percentage of HLA DR positive cells by FCM. Results Compared with group A,C and D,The expression of HLA DR increased significantly in group B （P〈0.01） and gradually decreased after anti-rejection therapy. Compared with group D, the expression of HI.A-DR increased in group A and C（P〈0.05）, but there was no statistical difference between group A and C（P〉0.05）. Conclusion The dynamic investigation of HLA DR expression by FCM would be helpful for the diagnosis of re jection and the estimation of anti rejection effect.