肾移植受者术后早期外周血树突状细胞亚群的动态变化及意义

Dynamic changes of dendritic cells subsets in kidney transplantation recipients

目的分析肾移植受者手术前后外周血中树突状细胞（DC）及其亚群骨髓源性DC（mDC）和浆细胞源性DC（pDC）的动态变化，探讨其与排斥反应的关系。方法检测28例肾移植受者术前，术后1、7和28d外周血中白细胞总数和单个核细胞数（PBMNC）；应用流式细胞术测定IX；及其亚群的数量和pDC／mDC。应用酶联免疫吸附试验法测定手术前后血清白细胞介素（IL）一10和IL-12水平。15名健康志愿者作为正常对照。结果移植组术前外周血DC总数、pDC和mDC数量均低于对照组（P〈O．05），但两组pDC／mDC的差异无统计学意义（P〉0．05）。移植组受者术后第1天外周血IX；数量骤然降低，然后缓慢上升，第28天恢复至手术前的73．7％；mDC；和pDC术后也降低，但mDC；恢复较快，pDC；恢复缓慢，至术后28d分别达到术前水平的80．1％和50．1％（P〈0．05）。术后第7天，移植组发生排斥反应者mDC数量高于未发生排斥反应者（P〈0．01）。受者手术前后IL-10和IL-12的水平变化不明显。结论DC及其亚群的变化与肾移植受者免疫状态有关，其变化异常提示受者免疫状态不稳定，在受者发生急性排斥反应时，可以作为诊断的参考指标。

Objective To analyze the dynamic changes of dendritic cells （DCs） and their subsets plasmacytoid DC （pDC） and myeliodDC （mDC） in peripheral blood of renal transplantation patients, and to confer the relationship between DCs subsets and graft rejection. Methods White blood cells （WBC） and mononuclear cells （PBMNCs） in peripheral blood of 28 renal transplantation recipients （test group） were measurcd before operation and at Ist, 7th, 28th day after operation. The number of DCs and subsets, and pDC/mDC were detected by using flow cytomctry, ancl IL-10 and IL-12 levels werc determined by using ELISA before and after operation. Ten volunteers （control group） served as controls. Results The levels of DCs, pDC and mDC before operation in test group were lower than in control group （P~ 0. 05）, but there was no statistically significant difference in pDC/mDC ratio between two groups （P〉0. 05）. The number of DCs in test group was significantly decreased on the first day after operation up to the lowest level, then slowly increased, and recovered 73. 7% at 28th day after operation. The number of mDC and pDC was also decreased after operation, but mDC recovered faster than pDC （P〈0. 05）. On the day 7th after operation, the number of mDC in the recipients with graft rejection was higher than in those without graft rejection in test group （P〈0. 01）. There was no significant difference before and after operation in the levels of IL-I 0 and IL-12 in test group. Conclusion The number of DCs and subsets are related to the recipients immune state, and their abnormality displays unstable immune state of recipients. The number of DCs and subsets can be used as an assistance index to diagnose graft rejection.