肾移植术后早期重症肺部感染患者内皮细胞功能监测及其临床意义

Evaluation of endothelial function in the early stage of renal allograft recipients accompanied with severe lung infection

目的:回顾性分析肾移植术后早期重症肺部感染患者的内皮细胞功能及其与疾病进展的关系。方法:14例肾移植术后早期重症肺部感染患者纳入本研究,32例健康志愿者作正常对照。内皮细胞功能损伤指标包括循环内皮细胞计数(CECs)、血管性血友病因子(vWF)、可溶性血栓调节蛋白(sTM)、血管细胞黏附分子(VCAM)和E选择素(ES),分别于入院后第1、4、7、14天观察其动态变化;同时检测感染前、入院后第1、7、14天外周血T淋巴细胞亚群(CD4+、CD8+)计数和比值,并观察其动态变化。结果:观察组所有患者内皮细胞损伤标志物均高于对照组(P<0.01),各项内皮细胞损伤标志物阳性率分别为CECs78.6%,vWF92.8%,sTM78.6%,VCAM85.7%,ES57.1%;病情改善后ES显著下降,其余内皮损伤标志物均有下降,但改善不明显。入院时所有患者CD4+、CD8+、CD4+/CD8+比值明显降低(P<0.01),经治疗后淋巴细胞计数回升。结论:肾移植术后早期重症肺部感染患者存在明显的内皮细胞损伤,与疾病的进展程度有关,随着疾病的缓解、免疫力重建,内皮细胞功能得以不同程度改善。

ABSTRACT Objective ：To investigate the association between endothelial function and the disease progression in the early stage of renal allograft recipients accompanied with severe lung infection. Methodology ： Fourteen renal allograft recipients and 32 healthy volunteers were included in this study. The markers of endothelial function including circulating endothelial cells （CECs） , yon Willebrand factor （vWF） , soluble thrombomodulin （ sTM ） , vascular cell adhesion molecule （VCAM） and E-seleetin （ES） were assessed at baseline. All of these endothelial function markers were rechecked ＇after 4th ,7th ,and 14th day after treatment. The number of CIM^＋ , CD8^＋ T lymphocytes was detected on 1^st ,7^th, 14^th day after treatment. Results：The patients with renal allograft had significantly higher plasma levels of CECs,vWF, sTM, VCAM and ES when compared to control subjects. The positive rates of CECs,vWF, sTM, VCAM and ES were 78.6% ,92.8% , 78.6% ,85.7% and 57.1% , respectively. With the improvement of the lung infection,the plasma level of ES was markedly decreased,the other markers were also gradually decreased,but not obviously. The number of CD4^＋ and CD8^＋ T cells was significantly decreased on admission day （P 〈 0. 01 ） compared with those of in the pre-infection periods and the ratio was also markedly decreased at the same time （ P 〈 0. 01 ）. The number of CD4^＋ , CD8^＋ T cells and ratio kept growing as the patients were recovering. Conclusion：The endothelial function is an useful marker to evaluate the progression of disease and clinical response to therapy in the early stage of renal allograft recipients accompanied with severe lung infection.