尿CD54^+淋巴细胞在肾移植急性排斥反应中的变化

Changes of urine CD54^+ lymphocytes in acute rejection after renal transplantation

背景:正常肾脏、肾小管上皮和血管内皮细胞仅有少量CD54表达,当发生急性排斥反应时,肾小管上皮细胞和血管内皮细胞CD54表达明显增加,同时大量白细胞浸润;间质浸润细胞和肾小管上皮细胞CD54表达增加。目的:探讨流式细胞仪检测尿CD54+淋巴细胞对移植肾急性排斥反应的诊断价值。方法:来自解放军成都军区总医院的肾移植后恢复正常者(n=18)、出现急性排斥反应者(n=8)、移植肾功不全者(n=9)以及健康志愿者(n=10)。流式细胞仪比较各组移植前后尿液中CD54+淋巴细胞比率变化。结果与结论:尿CD54+淋巴细胞在肾移植患者出现排斥反应时明显增加(P<0.01),抗排斥治疗后逐渐下降。移植肾功能正常者和移植肾功不全者CD54轻度升高。提示尿液中CD54+淋巴细胞水平能准确反映肾移植物移植后患者的免疫状态,可作为肾移植后急性排斥反应的特异标志。

BACKGROUND： The expression of CD54 is low in normal kidney, renal tubular epithelium and vascular endothelial cells. CD54 expression in renal tubular epithelial cells and vascular endothelial cells increases obviously when acute rejection occurres. In the meantime, the CD54 expression level in renal tubular epithelial cells increases along with interstitial renal edema and massive leukocyte infiltration. OBJECTIVE： To assess the value of flow cytometer detection for urine CD54＋ lymphocytes in the diagnosis of acute rejection after renal transplantation. METHODS： Participants were renal transplant recipients from General Hospital of Chengdu Military Area Command of Chinese PLA, including patients obtained normal renal function （n=18）, patients with acute rejection （n=8） and patients with graft dysfunction （n=9）. Healthy volunteers were included as control （n=10）. Urine CD54＋ lymphocyte rates of each group were compared by flow cytometer before and after transplantation. RESULTS AND CONCLUSION： The expression of urine CD54＋ lymphocytes in renal transplant recipients increased significantly during the rejective time （P 〈 0.01）, and reduced gradually after anti-rejction treatment. The expression of CD54 increased moderately in patients obtained normal renal function and patients with graft dysfunction. These findings indicate that CD54＋ lymphocyte level in urine can accurately reflect the immune condition of renal transplant recipients and could be used as a specific parameter in the diagnosis of acute rejection after renal transplantation.