肾移植受者不同免疫诱导方案治疗后TCR高可变区监测结果差异分析

Analysis of the difference of the monitoring results of TCR high variable area in renal transplant recipients after treatment with different immune induction schemes

目的观察总结不同诱导方案对亲属活体肾移植受者T淋巴细胞受体(TCR)高可变区监测结果的差异影响及其意义。方法采用非干预性纵向观察,根据术后早期使用免疫诱导抗体不同,将12例亲属活体肾移植受者分为巴利昔单抗组(BLX组,4例)、抗人类胸腺免疫球蛋白组(rATG组,4例)和甲泼尼龙组(MP组,4例),建立免疫组库分析术前第3 d(服药前)和术后1周、2周、1个月外周血TCR-CDR3克隆多样性、克隆频率、克隆变化模式等差异,并通过与免疫相关标志物表达的相关性,分析各组结果差异及可能存在的临床意义。结果移植受者和移植肾均存活;术后免疫抑制方案按照受者免疫状态调整用药剂量,未出现急性排斥反应,rATG组出现2例轻度感染;TCR-CDR3克隆多样性、克隆频率、克隆变化模式及部分免疫标志物指标等在各组间及组内均发生改变,其中rATG组改变最明显。结论受者外周血TCR-CDR3表达谱在不同免疫诱导方案应用后出现不同的表达特点,与免疫状态的改变显示出一定相关,在亲属活体肾移植受者中可能成为一种对感染或排斥有预测价值的检测方法。

Objective To observe and summarize the effect of different induction schemes on the highly variable region of T-lymphocyte receptor(TCR)in living relative renal transplant recipients.Methods According to the early use of immune-induced antibody,12 living relative kidney transplant recipients were divided into three groups:baliximab group(BLX group,4 cases),Rabbit anti human thymus immunoglobulin group(rATG group,4 cases)and methylprednisolone group(MP group,4 cases).The immune group library was established to analyze the three days before operation(before administration)and one week,two weeks and one month after operation Blood TCR-CDR3 Clone Diversity,clone frequency,clone change mode and other differences,and through the correlation with the expression of immune related markers,analyze the differences of results in each group and the possible clinical significance.Results There were no acute rejection and 2 cases of mild infection in rATG group.The clonal diversity,clonal frequency,clonal change mode and some immune markers of TCR-CDR3 were changed in all groups and groups,especially in rATG group.Conclusions The expression profile of TCR-CDR3 in the peripheral blood of recipients showed different expression characteristics after the application of different immune induction schemes,which was related to the change of immune status to a certain extent.It may become a detection method with predictive value for infection or rejection in living relative kidney transplant recipients.