肾移植术后动态监测细胞因子的临床意义

Evaluation of sequential monitoring of cytokines in renal allograft recipients

目的 :探讨TNF α、IL 6在肾移植术后急性排斥反应、感染、CsA中毒时的变化。方法 :采用ELISA法 ,动态监测10 6例患者移植前后血清TNF α、IL 6及尿液TNF α。结果 :肾移植术前TNF α、IL 6与对照组无显著性差别 ,术后第 1天明显升高 ,TNF α与IL 6分别于 1w及 2w左右降至术前水平。急性排斥反应前 1～ 3d血清TNF α、IL 6及尿液TNF α即有不同程度升高 ,抗排斥治疗有效后迅速下降。并发感染时血清TNF α、IL 6显著升高 ,尿液TNF α无升高 ,CsA中毒时均无明显变化。结论 :结合临床动态监测血清TNF α、IL 6及尿TNF α可做为辅助诊断急性排斥反应的免疫生物学指标。

Objective:To study the levels of TNF α in serum and in urine and IL 6 in serum of renal allograft recipients with acute rejection, infection and CsA induced nephrotoxicity.Methods:The sequential monitoring of TNF α and IL 6 was conducted by ELISA technique in 106 patients before and after renal transplantation.Results:The levels of IL 6 and TNF α increased in the first day posttransplant, decreased and stabilized after 1 to 2 weeks, and increased 1 to 3 days prior to the clinical diagnosis in acute rejection, then decreased with effective treatment. IL 6 and TNF α increased in serum in infection and had no difference in urine. TNF α in serum and in urine and IL 6 in serum had no significant difference in CsA induced nephrotoxicity.Conclusion:It suggests that the sequential monitoring of IL 6 and TNF α of renal allograft recipients can be used to estimate the function of graft, as markers of the early diagnosis of acute rejection.