动态监测HLA Ⅰ类分子与降钙素原用于鉴别肾移植术后急性排斥反应与感染的价值

Value of dynamic monitoring of HLA Ⅰ and procalcitonin on differentiation of acute rejection from infection after renal transplantation

目的探讨动态监测患者肾移植术后外周血淋巴细胞表面人类白细胞抗原Ⅰ类分子(humanleukocyteantigenⅠ,HLAⅠ)及降钙素原(procalcitonin,PCT)水平用于鉴别急性排斥反应(AR)及感染的价值。方法根据术后临床表现、肾功能检查、影像学及移植肾穿刺活检结果将99例(102例次)肾移植受者分为3组,AR组18例次,感染组14例次,移植后正常组70例次,并选取齐鲁医院20名健康献血者作为正常对照组。采用流式细胞术(flowcytometry,FCM)检测研究对象外周血淋巴细胞表面HLAⅠ类分子表达水平;采用免疫荧光分析法定量检测研究对象血清PCT水平。结果肾移植受者术后发生AR或严重细菌感染时,淋巴细胞表面HLAⅠ类分子水平均明显升高,两组比较差异无统计学意义(P>0.05),但感染组的PCT阳性率明显高于AR组(P<0.01)。结论与监测外周血淋巴细胞表面HLAⅠ类分子水平相比,监测血清PCT水平变化在鉴别诊断肾移植术后AR与严重细菌感染方面更加敏感。

Objective To investigate the value of human leukocyte antigen（HLA）Ⅰon peripheral lymphocytes and procalcitonin（PCT）level on differential diagnosis of acute rejection（AR）and infection after renal transplantation.Methods Ninety-nine renal transplant recipients（102 cases）were divided into 3 groups,according to clinical symptoms,renal function examination,imaging and renal allograft biopsy after transplantation.There were 18 cases in AR group,14 cases in infection group and 70 cases in post-transplantation normal group.Twenty healthy blood donors in Qilu hospital were selected as control group.The level of HLA Ⅰ on peripheral lymphocytes was detected by flow cytometry（FCM）and the level of PCT in serum was detected by immunofluorescence.Results The level of HLA Ⅰin patients who underwent AR or severe bacterial infection after renal transplantation was increased,but there was no significant difference between the two groups（P〈0.05）.The positive rate of PCT in infection group was significantly higher than that in AR group（P〈0.01）.Conclusions Compared with the level of HLA Ⅰon peripheral lymphocytes,the changes of plasma PCT level was more sensitive to differentiate AR from severe bacterial infection after renal transplantation.