肾移植早期尿淋巴细胞表型分析的应用价值

Immunophenotyping of urine lymphocytes by flow cytometer in early kidney transplantation

目的 :探讨尿淋巴细胞表型分析在肾移植早期免疫监测中的临床应用价值。方法 :以流式细胞技术对 37例肾脏移植患者的 10 5份尿样本进行尿淋巴细胞表型分析 ,测定 CD3 、CD4、CD8、CD1 9、CD2 5、HL A- DR阳性细胞百分率 ,其结果在急性排斥反应组和肾功能稳定组之间进行比较。结果 :与肾功能稳定组比较 ,急性排斥反应组尿淋巴细胞表达 HL A- DR数增多非常显著 (P <0 .0 1) ,CD8和 CD2 5细胞增多显著 (P <0 .0 5 ) ,而 CD3 、CD4、CD1 9细胞数变化不显著 (P >0 .0 5 )。在诊断移植肾急性排斥反应上 ,HL A - DR阳性样本的诊断敏感性和特异性分别达 86 .96 %和 90 .2 4% ,CD8和 CD2 5阳性样本的阴性预测值分别达 86 .79%和 85 .71%。结论 :尿淋巴细胞表型分析可间接反映出移植肾内的免疫状态 ,是诊断和鉴别诊断移植肾急性排斥反应的有效方法 ,适用于肾移植早期的免疫监测。

Purpose:To evaluate the clinical value of immunophenotyping of urine lymphocytes by flow cytometer in early kidney transplantation.Methods:Analysis of urine lymphocyte immunophenotype was performed on the 105 urine samples of 37 early kidney transplant recipients. The percentages numbers of CD 3, CD 4, CD 8, CD 19, CD 25 and HLA-DR positively stained cells were recorded and compared between acute rejection group and stable graft function group.Results:Compared to stable graft function group, HLA-DR positively stained cells were very significantly increased(P< 0.01)in acute rejection group, CD 8 and CD 25 cells also significantly increased(P< 0.05), and CD 3, CD 4 and CD 19 cells were not significantly changed. For evaluation of their ability to diagnose acute renal rejection, higher expression of HLA-DR had sensitivity and specificity value of 86.96% and 90.24% respectively, and higher expression of CD 8 and CD 25 had value of 86.79% and 85.71% respectively. Conclusions:Immunophenotyping of urine lymphocytes by flow cytometer is a useful tool in monitoring immunoreactive change of renal graft.It should be a useful guideline for diagnosis and differentiation of acute rejection in early kidney transplantation.