供者DC介导的淋巴细胞反应在肾移植后个体化免疫抑制治疗中的作用

Application of donor dendritic cells-mediated recipient lymphocyte reaction after living related kidney transplantation in individualized immunosuppressive therapy

目的探讨根据供者骨髓源性树突状细胞（DC）介导肾移植受者淋巴细胞反应指导肾移植术后免疫抑制剂个体化应用的价值。方法2008年1月至2010年1月间接受亲属活体供肾移植者30例，根据药物剂量调整依据的不同分为试验组和对照组，每组各15例，免疫抑制方案同为他克莫司（Tac）＋吗替麦考酚酯（MMF）＋皮质激素。试验组术后根据受者淋巴细胞对供者DC的反应强度，结合血Tac、MMF浓度调整药物剂量；对照组术后仅根据血药浓度调整药物剂量。术后每月检查肝功能、肾功能、血常规、尿常规、血糖；随访时间为1年。结果随访期内试验组急性排斥反应的发生率为13．3％，对照组为46．7％（P〈0．05）；试验组和对照组的感染发生率分别为6．7％和40．0％（P〈0．05）；试验组和对照组不良反应的总体发生率分别为13．3％和46．7％（P〈0．05）。两组各时间点的血清肌酐的差异无统计学意义（P〉0．05）。结论利用供者骨髓源性DC介导肾移植受者淋巴细胞反应结合治疗药物血药浓度监测作为免疫监测指标，指导肾移植术后免疫抑制剂个体化应用，较仅利用血药浓度监测更全面、准确。

Objective To explore the feasibility of mediating recipient lymphocyte reaction with donor dendritic cells （DCs） in renal allograft recipients to guide individualized immunosuppressive therapy. Methods From Jan. 2008 to Jan. 2010, 30 recipients received living related kidney transplantation were successively and divided into 2 groups according to the strategies of the correction of the dosage of immunosuppressant, 15 in each group. The strategy of immunosuppressive therapy in both groups was Tac ＋ MMF ＋ Pred. The correction of the dosage of immunosuppressant in experimental group was conducted by recipient lymphocyte reaction with donor DC （LR） combined with Tac and MPA blood concentration monitoring. Only blood concentration monitoring of drugs was applied in control group. Examinations of liver and renal function, blood and urine routine as well as blood sugar were done monthly for 1 year. Results During the follow-up period, the rate of acute rejection in experimental group and control group was 13. 3 % and 46. 7 0% respectively （P〈0. 05）; the rate of infection in experimental group and control group was 6. 7% and 40. 0% （P〈0. 05） respectively; the adverse reaction rate in experimental group and control group was 13.3% and 46. 7% （P〈0. 05）. There was no significant difference in the serum creatinine level between the two groups at each observation point. Conclusion The application of combined recipient LR with donor DC and blood concentration monitoring of drugs in individualized immunosuppressive therapy is more comprehensive and accurate.