免疫细胞功能分析在监测肾移植受者免疫状态中的应用

Application of immune cell functional assay in monitoring immune status in renal transplantrecipients

目的评估免疫细胞功能分析（ImmuKnow ATP测定）在监测肾移植受者免疫状态中的价值。方法2010年3月至2010年12月在浙江大学医学院附属第一医院肾脏病中心首次接受同种肾移植的131例受者被纳入本研究。根据临床情况分为：健康对照（HC）组；肾移植术前（Pre-Tx）组；术后稳定（Tx）组；术后感染（Infect）组；排斥反应（AR）组和急性肾损伤（AKI）组6组。分别于术前、术后2周、1月、3月、6月及异常时间点（出现排斥，感染等）动态监测各组患者及健康人群的免疫细胞功能，分析免疫细胞功能与淋巴细胞亚群分析（CD4/CD8）、混合淋巴细胞反应（MLR）及他克莫司（FK506）血药浓度的相关性。结果ATP浓度检测结果显示：Pre-Tx组与HC组比较差异无统计学意义；与Pre-Tx组比较，肾移植术后2周、1月组患者ATP浓度升高（均P〈0．01）；随着移植时间延长ATP浓度趋于平稳；AR组ATP浓度显著高于Tx组，感染组，AKI组（均P〈0．01）。logistic回归分析结果显示：肾移植受者的ATP浓度与MLR、CD4/CD8和血FK506浓度无相关关系（分别R^2=0．0072，R。=10^-6，R^2=0．004；均P〉0．05）。结论肾移植受者术后1月内免疫细胞功能较强，随着时间延长趋于稳定。ImmuKnow法检测的ATP值对急性排斥反应发生有一定的预示作用。

Objective To evaluate the value of immune cell functional assay （ImmuKnow CD4＋ T cell ATP assay） in monitoring immune status in renal recipients. Methods A total of 131 adult renal transplant recipients who received transplantation for the first time were under investigation. According to the dynamic monitoring ATP concentration before operation, 2 week, 1, 3, 6 months after operation and during infect or rejection, samples were divided into the following groups： health control group （HC）, pretransplant （Pre-Tx） group, stable （Tx） group, infect group, acute rejection （AR） group, acute kidney injury （AKI） group. Immune cell functions were detected by ImmuKnow CD4＋ T cell ATP assay. Lymphocyte subsets （CD4＋/CD8＋） were analysed and serum concentrations of FKS06 were tested. Mixed lymphocyte reaction（MLR） was analysed. Results The ATP concentration was no significant difference between Pre-Tx and HC group. The ATP concentration of 2 weeks, 1 months after operation were significantly higher than Pre-Tx group （P 〈 0.01）. After 3 months, 6 months follow-up, the ATPconcentration stabilized with time. The ATP concentration of AR group was significantly higher than other three groups （Tx, infect and AKI group, all P 〈 0.05）. The correlation coefficient between the ATP concentration and MLR, CD47CD8＋, FKS06 level were R^2 = 0.0072, R^2 = 10 6, R2= 0.004 respectively （all P 〉 0.05）. Conclusions The cell-mediated immunity of recipients is relatively strongger during the first month after transplantation. The ATP concentration is not related to the levels of MLR, CD4＋/ CD8＋, FK506. ImmuKnow ATP assay is a valuable predictor in acute rejection diagnosis.