CD4＋T淋巴细胞内ATP水平测定在肾移植受者个体化免疫抑制治疗中的意义

Application of cell immnune function monitoring by Cylex ImmuKnow assay for individual immunosuppressive therapy in renal transplantion recipients

目的探讨Cylex ImmuKnow法测定肾移植受者外周血CD4＋T淋巴细胞内三磷酸腺苷（ATP）水平在肾移植受者个体化免疫抑制治疗中的意义。方法以2014年1月至2015年3月间发生肺部感染的肾移植受者44例为研究对象，应用CylexImmuKnow法动态测定其感染前、感染治疗过程中及感染控制后外周血CD4＋T淋巴细胞内的ATP水平。根据有无应用监测结果指导肾移植受者肺部感染恢复期免疫抑制剂方案的调整，分为经验治疗组（22例）和ImmuKnow监测组（22例）。另以同期行肾移植手术的肾功稳定受者32例和健康体检者20例分别作为对照。44例肾移植受者术后常规应用钙调磷酸酶抑制剂（CNI，即环孢素A或他克莫司）＋吗替麦考酚酯＋皮质激素三联免疫抑制治疗，围手术期应用抗人T淋巴细胞免疫球蛋白诱导治疗。结果肾移植受者发生肺部感染时外周血CD4＋T淋巴细胞内ATP水平为（151．3±71．4）ng／ml，低于健康对照组的（421．29±131．61）ng／ml（P〈0．05）；也低于同期肾功能稳定组受者的（308．3±141．3）ng／ml（P〈0．05）。感染组感染控制后外周血CD4＋T淋巴细胞内ATP水平逐渐回升至感染前水平。ImmuKnow监测组受者的住院时间为（12．27±0．74）d，经验治疗组为（16．64±1．98）d，差异具有统计学意义（P〈0．05）。感染恢复过程中，ImmuKnow监测组中有1例受者发生急性排斥反应（4．5％，1／22），而经验治疗组有3例发生急性排斥反反应（13．60．4，3／22），差异无统计学意义（P〉0．05）。结论应用CylexImmuKnow检测肾移植受者外周血CD4＋T淋巴细胞内ATP水平可在一定程度上反映受者的细胞免疫状态，对于肾移植术后肺部感染患者的个体化免疫抑制治疗具有一定指导意义。

Objective To investigate the correlation between immune cell function and the infection after renal transplantation through monitoring of immune function intracellular ATP by Cylex ImmuKnow assay, and explore its significance in individual immunosuppressive therapy of renal transplantion recipients. Method We collected 44 renal transplant patients suffered from pulmonary infection from January 2014 to March 2015. The patients were divided into two groups according to the clinical status, namely, ImmuKnow monitoring group （n = 22） and empirical treatment group （n = 22）. Thirty-two non-infection recipients were collected as controls. All the kidney transplantation recipients received immunosuppressive therapy based on calcineurin inhibitors, mycophenolate mofetil and prednisone, and ATG for induction therapy after transplantation. The immune cell function levels were measured by Cylex ImmuKnow assay. The whole blood samples were collected before infection onset, at the time of infection, and 1 week after infection resolution. Result When infection occurred, ATP concentrations in CD4＋ T cells of the kidney transplant recipients were significantly lower than those in non-infection group [（151.30±71.35 ng/mL vs. （308. 34 ± 141.29 ng/mL, P〈0. 05）. When the infection got controlled, the ATP concentrations in CD4＋ T cells increased to those before infection occurred. The average hospitalization time in ImmuKnow monitoring group was 12. 27 ± 0. 74 days, which was significantly shorter than in empirical treatment group （16. 64± 1.98 days, P〈0. 05）. The incidence of acute rejection was 4. 5% in ImmuKnow monitoring group, and 13. 6M in empirical treatment group （P〈0. 05）. Conclusion The examination of ATP in CD4＋ T cells by Cylex Immuknow assay could reflect the status of cellular immunity, provide reliable and objective basis for the diagnosis and treatment of infection after renal transplantation, and guide the clinical individualized immunosuppressive therapy.