尿流式细胞学在诊断移植肾急性排斥反应中的应用价值

Clinical value of Urine flow cytometry in diagnosing actue renal allograft rejection

目的 探讨尿流式细胞学在诊断移植肾急性排斥反应中的临床应用价值。方法 对43例肾移植受者的 1 1 6份尿样本进行尿流式细胞学分析 ,并将急性排斥组和肾功能稳定组的分析结果进行比较。结果 急性排斥反应组尿淋巴细胞总数以及HLA DR+ 淋巴细胞数显著增多 ,与肾功能稳定组比较 ,P <0 .0 1 ;CD8+ 细胞亦增多 (P <0 .0 5) ;而CD3+ 、CD4+ 、CD1 9+ 细胞数变化两组差异不显著 (P >0 .0 5)。在诊断移植肾急性排斥反应上 ,HLA DR阳性样本和淋巴细胞数阳性样本的诊断敏感性和特异性分别达 95 .2 %、90 .5 %和 92 .6 %、87.4%。结论 尿流式细胞学分析可反映移植肾内的免疫状态 ,尿淋巴细胞数的显著增多和尿HLA DR+

Objective To evaluate the clinical value of urine flow cytometry in diagnosing acute renal allograft rejection.Methods Urine flow cytometry was performed on the 116 urine samples of 43 kidney transplant recipients, and results were compared between acute rejection group and stable graft function group.Results Compared to stable graft function group, HLA DR positively stained cells and urine total lymphocyte numbers were significantly increased( P < 0.01 )in acute rejection group, and CD3, CD4 and CD19 were not significantly changed. For evaluation of their ability to diagnose acute renal rejection, higher expression of HLA DR and higher numbers of urine lymphocyte had specificity value of 90.5% and 87.4% , respectively, and sensitivity value of 95.2% and 92.6% , respectively.Conclusion Urine flow cytometry is a useful tool in monitoring immunoreactive change of renal graft. Markedly increased HLA DR expression and higher lymphocyte numbers in urine should be a useful guideline for diagnosis of acute rejection.