内皮素在移植肾急性或慢性排斥反应中的变化

Changes of endothelin in acute and chronic rejection after kidney transplantation

目的:探讨内皮素-1(ET-1)在移植肾急性或慢性排斥反应(简称急排或慢排)中的变化。方法:对43例肾移植术1年后患者(对照组18例,急排组9例,慢排组16例)行血液、尿液ET-1、肌酐、β_2-M排泄量等测定,对部分急排和慢排移植肾行ET-1及A受体免疫组织化学染色。结果:急排组血、尿ET-1高于对照组(P<0.01);急排组尿ET-1明显高于慢排组(P<0.01),两组间血ET-1的差异无明显意义(P>0.05);急排和慢排时血ET-1均与血肌酐呈正相关(P<0.01),尿ET-1均与尿β_2-M排泄量呈正相关(P<0.01);免疫组织化学染色显示ET-1与ET A受体在移植肾内的分布较一致,与相应病理类型大致吻合,急排和慢排检测时,其染色强度明显高于正常肾脏。结论:检测尿ET-1排泄量可鉴别急排和慢排,术后监测尿ET-1较监测血ET-1更有意义;在急排和慢排中ET系统可能担当重要角色。

Purpose:To study the changes of endothelin(ET) in plasma,urine and allograft in acute or chronic rejection. Methods: The plasma and urine level of ET were determined by radioimmunoassay in 43 patients 1 year after kidney transplantation, including 9 patients with acute rejection, 16 patients with chronic rejection and 18 patients with normal kidney function who served as controls. Serum creatinine, urinary ffc-M excretion were measured simultaneously. Immunohistochemistry were used to determine the distribution of ET-1 and ET A receptor in 5 cases of acute rejection and 6 cases of chronic rejection. Results:The plasma and urine level of ET in acute rejection was statistically higher than controls( P <0. 01). The urine level of ET in acute rejection was also statistically higher than in chronic rejection( P <0. 01) , whereas the plasma level of ET was not. The plasma level of ET was significantly correlated positively with serum creatinine, the same as the correlation of the urinary ET excretion with the urinary (32-M ( P<0. 01). The distribution of ET-1 was similar with that of ET A receptor,and was accordance with the pathologic change. Immunolabelling was significantly increased in kidneys with acute or chronic rejection compared with controls. Conclusions: 1)The urinary ET excretion could be used to distinguish between acute rejection and chronic rejection. It is more important to determine the urine level of ET than the plasma level of that after transplantation. 2) We consider that the ET system may play an important role in the pathomechan-isms underlying acute or chronic renal allograft rejection.