肾移植术后外周血淋巴细胞CD_3/Fas的流式细胞动态检测及其临床意义

FLOW CYTOMETRY DETERMINATION OF CD_3/Fas IN PERIPHERAL BLOOD IN THE PATIENTS WITH KIDNEY TRANSPLANTATION AND ITS IMPLICATION

目的 :探讨尿毒症患者肾移植前后外周血淋巴细胞CD3 /Fas的变化及其意义。方法 :提取患者的外周血淋巴细胞 ,加入双荧光标记的鼠抗人单克隆CD3 /Fas,流式细胞分析仪进行测定。结果 :尿毒症患者外周血淋巴细胞CD3 + /Fas+ 较健康对照者明显升高 (分别为 6 .5 3%± 3.0 6 %和 0 .18%± 0 .0 9% ,P <0 .0 1) ;以 9.5 9%为临界值 ,术前CD3 + /Fas+ 水平低者 ,预后较好 ;肾移植前后无论何时CD3 + /Fas+ 水平 >10 .0 %者急性排斥反应发生率高 ;经激素冲击治疗后 1周CD3 + /Fas+ 水平迅速下降者 ,急性排斥反应逆转者高。术后CD3 + /Fas+ 水平低于初始水平或有增高但又迅速下降者预后好。结论 :肾移植术后动态监测外周血淋巴细胞CD3 + /Fas+ ,有助于判断预后 ,对及时治疗和抗排斥反应疗效的评价具有一定意义。

Objective:To investigate the changes of CD 3/Fas in peripheral blood in the patients with kidney transplantation and its implication. Methods:The lymphocytes from the peripheral blood in the patients in different periods after kidney transplantation were immunologically labeled by dual color fluorescent monoclonal antibodies CD 3/Fas and determined by using flow cytometry (FCM). Results: The level of CD 3 +/Fas + in the patients before renal transplantation was higher than that in the normal subjects (6.53%±3.06% vs 0.18%±0.09%, P < 0.01 ). The cutoff for CD 3 +/Fas + was 9.59%.It had better prognosis for the patients with lower level of CD 3 +/Fas + before kidney transplantation. It had more acute rejection whenever the level of CD 3 +/Fas + was above 10%. The acute rejection could reverse in the group with CD 3 +/Fas + rapid decline after steroid pulse treatment within 1 week. Conclusions:The dynamic determination of CD 3 +/Fas + in peripheral blood is helpful to estimate the prognosis of the patients with kidney transplantation, and is important for the treatment of rejection and the evaluation of the cutative effects of antirejection.