细胞因子与小肠移植急性排斥反应相关性研究

Evaluation of perioperative serum cytokine level in acute rejection in human living-related small bowel transplantation

目的观察我国首例活体部分小肠移植患者围手术期及急性排斥反应期间相关细胞因子的变化。探讨细胞因子与急性排斥反应的相关性。方法受者男性,18岁,因短肠综合征而接受小肠移植,供体男性,44岁,为受体之父,取供体回肠末段150cm,移植肠血管与受体肾下腹主动脉、下腔静脉吻合,移值肠近端与受体空肠近端行端端吻合,移植肠远端与受体空肠远端行端侧吻合,移植肠末端10cm造口作为观察窗,免疫抑制方案为FK506、骁悉、强的松龙,双抗夹心ELISA法测定患者血清IL-2R,IL-4,IL-6,IL8水平。结果患者血清IL-2R,IL-8水平在术后d1显著升高,形成第一个高峰。血清IL-2R,IL-8的第二个高峰出现于术后d67发生移植物急性排斥反应时,IL-4,IL-6无变化。急性排斥反应经治疗迅速缓解,目前患者已健康生存19mo。结论在人活体部分小肠移植中,血清IL-2R,IL8水平与急性排斥反应密切相关,可作为重要的预警指标。

AIM To investigate the perioperative serum levels of IL-2R, IL-8 in the first case of living-related small bowel transplantation in China and to study the interrelationship between the changes in serum IL-2R, IL-8 levels and the acute small bowel allograft rejection, METHODS An 18-year-old boy with short gut syndrome underwent the living-related small bowel transplantation, with the graft from his father (44 year old). A segment of 150cm distal small bowel was resected from the donor. The donor ilecolic artery and vein were anastomosed to the recipient infrarenal aorta and vena cava respectively, The intestinal continuity was restored with an end-to-end anastomosis between the recipient jejunum and donor ileum, and the distal end was fistulized. Posttransplant immunosuppression was initially administered with FK506, MMF and prednisone. Serum levels of IL-2R, IL-4,IL-6, IL-8 were analyzed by a solid-phase double ligand ELISA method. RESULTS IL-2R, IL-8 serum levels increased at Ⅰ POD, forming the first peak level. The second peak level occurred at 67 POD with acute small bowel allograft rejection, the acute small bowel allograft rejection was cured immediately, the recipient has remained healthy for 19 months. CONCLUSION In the human living-related small bowel transplantation,there was close correlation between serum IL-2R, IL-8 level and the acute small bowel allograft rejection. It could be enlisted as the most important predictive signs of acute small bowel allograft rejection.