外周血嗜酸性粒细胞水平与肝移植术后迟发性急性排斥反应的关系

Relationship between the level of eosinophil in peripheral blood and late acute rejection after liver transplantation

目的评价外周血嗜酸性粒细胞诊断肝移植术后迟发性急性排斥反应(AR)的价值。方法回顾性分析中山大学附属第三医院37例肝移植术6个月后行肝穿刺活检患者的临床资料,根据病理确诊结果,比较迟发性AR组(AR组,24例次)和非迟发性AR组(非AR组,16例次)患者肝穿刺当日或前1d血常规中白细胞的分类,根据受试者工作特征(ROC)曲线确定嗜酸性粒细胞绝对值和比例的最佳截断值,分析其诊断迟发性AR的敏感度和特异度。结果AR组患者的外周血嗜酸性粒细胞比例显著高于非AR组。ROC曲线分析显示嗜酸性粒细胞绝对值和比例分别为0.145×109/L和0.023时约登指数最高(分别为0.333和0.625),ROC曲线下面积分别为0.746和0.813。分别以0.145×109/L和0.023作为嗜酸性粒细胞绝对值和比例升高的截断值,诊断AR的敏感度和特异度分别为0.46和0.88、0.75和0.88。当嗜酸性粒细胞绝对值≥0.285×109/L和比例≥0.03时,诊断AR的敏感度和特异度分别为0.25和1.0、0.50和1.0,所有嗜酸性粒细胞绝对值≥0.285×109/L者的细胞比例均≥0.03。结论肝移植术后6个月,延迟性AR患者的外周血嗜酸性粒细胞比例显著高于非延迟性AR患者,嗜酸性粒细胞比例≥0.03对诊断迟发性AR具有很高的临床价值。

Objective To evaluate the value of eosinophil in peripheral blood in diagnosing late acute rejection （AR） after liver transplantation （LT）. Methods Clinical data of 37 cases underwent liver biopsies at 6 months after LT were retrospectively analyzed. According to histopathologie findings, differential white blood cell counts in blood routine were compared between AR group （ n = 24 ） and non-acute rejection （non-AR） group （n = 16） at the same day or the day before liver biopsy. The absolute value and optimal cut- off value of ratio of eosinophil was determined by receiver operating characteristic （ROC） curve to analyze the sensitivity and specificity in diagnosis of late AR. Results The ratio of eosinophil in peripheral blood in AR group was significantly higher than that in non-AR group. The ROC curve analysis showed that when the absolute value and ratio of eosinophil was respectively 0. 145 ×10^9/L and 0. 023, the Youden index was highest （0. 333 and 0. 625, respectively） with the area under the ROC curve （AUC） of 0. 746 and 0. 813 respectively. The sensitivity and specificity for them to diagnose the late AR was 0.46 and 0. 88, and 0. 75 and 0. 88, respectively. When the absolute value of eosinophil ≥ 0. 285 ×10^9/L and ratio of eosinophil ≥ 0. 03, thesensitivity and specificity to diagnose the late AR was 0. 25 and 1.0, and 0. 50 and 1.0, respectively. All patients with absolute value of eosinophil ≥ 0. 285×10^9/L had ratio of eosinophil ≥ 0. 03. Conclusions Ratio of eosinophil in peripheral blood at 6 months after LT in late AR patients is significantly higher than that in non-AR patients. Ratio of eosinophil≥ 0. 03 is of good value to diagnose late AR.