血小板T细胞活化抗原1与移植肾急性排斥反应的相关性

Changes of serum soluble and membranous platelet - T cell activation antigen 1 in renal transplant recipients with acute rejection

目的 :观察肾移植术后血清可溶性血小板T细胞活化抗原 1 (sPTA1 )水平及细胞膜性血小板T细胞活化抗原 1 (mPTA1 )的表达与排斥反应 (AR)的相关性。 方法 :选取 1 7例围手术期同种尸体肾移植患者以及 2例术后超过 1年的AR的患者 ,根据患者的不同病况每周采取血样 ,采用夹心ELISA法测定血清sPTA1水平 ,流式细胞术检测淋巴细胞mPTA1表达 ,对明确有排斥反应、可疑有排斥反应以及不能区分排斥反应的患者在B超引导下行移植肾活检穿刺病理检查。 结果 :术前sPTA1水平及mPTA1表达与对照无显著差异 (P >0 0 5)。术后第 1天sPTA1即有高水平的表达 ,与对照组差异显著 (P <0 0 5)。 1 9例尸体肾移植患者中经病理证实的 5例排斥反应患者sPTA1显著升高 ,mPTA1表达增强 ,与对照组差异非常显著 (P <0 0 1 )。经激素冲击治疗后 ,血清sPTA1下降 ,mPTA1表达下降。而且sPTA1水平变化早于AR的临床表现 ,持续时间较长。 结论 :PTA1可以作为移植物AR的预警和监测指标 ,与病理检查的结果有较好的一致性 ;

Objective:Platelet and T cell activation antigen 1( PTA1 )has been reported involved in autoimmune disorders and in transplantation models. In this study, we investigate the changes of serum soluble PTA1 (sPTA1) and membranous PTA1 (mPTA1)on lymphocytes in renal allograft recipients with clinically and pathologically diagnosed acute rejection. Methodology:Nineteen renal allograft recipients with acute rejection were included in this study. The diagnosis of acute rejection were made according to the clinical symptoms and histopathologic findings of allograft biopsy. Blood samples were collected each week after the establishment of the diagnosis, and in 3 recipients a blood sample was collected 1 3 days before the diagnosis. Solid phase ligand ELISA was used in analyzing serum sPTA1, and Flow cytometry employed in examining the expression of PTA1 on lymphocytes. Results:In the recipients of renal allograft recipients, the level of serum sPTA1 was found remarkably increased after the establishment of the diagnosis of acute rejection. Enhanced expression of mPTA1 on lymphocytes was found after the diagnosis of acute rejection. Change of serum level of sPTA1 was observed days before the appearance of clinical symptoms and even before the changes of histopathology. And interestingly, the levels of serum sPTA1 and the expression of mPTA1 decreased within days after the use of anti rejection immunosuppressant. Conclusion:PTA1 is a sensitive parameter for the diagnosis of acute rejection in renal allograft recipients and also a valuable one for monitoring the therapeutic response of anti rejection therapy.