肾移植术后血清IL—6水平的动态监测及临床意义

目的：观察肾移植术后发生急性排斥反应、感染、CsA中毒时血清IL-6的变化,以探讨IL-6在急性排斥反应的早期诊断、鉴别诊断中的意义。方法：采用双抗体夹心酶联免疫吸附法,对106例肾移植患者血清IL-6活性水平于肾移植手术前后进行动态监测。结果：肾移植术前,IL-6与对照组比较差别无显著性意义。术后第1天明显升高,2周左右基本降至术前水平。发生急性排斥反应前1-3天。血清IL-6即有升高,峰值出现在抗排斥反应治疗的当天,经甲基本降至术前水平,发生急性排斥反应前1-3天,血清IL-6即有升高,峰值出现在抗排斥反应治疗的当天,经甲基泼尼松尼（MP）冲击有效后迅速下降,治疗无效者,血清IL-6持续在高水平,并发感染时,IL-6也显著升高,与急性排斥反应组相比差别无显著性意义;而CsA中毒时,IL-6变化不明显。结论：动态监测IL-6可以作为急性排斥反应的早期诊断,鉴别诊断的免疫生物学指标。     

血清可溶性血管细胞粘附分子-1测定在肾移植急性排斥反应中的临床意义

目的:探讨血清可溶性血管.细胞粘附分子-1(sVCAM-1)测定在肾移植术后免疫学监测中的价值.方法:采用酶联免疫吸附法(ELISA)动态监测56例肾移植患者术后sVCAM-1水平的变化.结果:肾移植患者术后sVCAM-1水平呈规律性变化,急性排斥反应组sVCAM-1水平明显高于移植肾功能稳定组和CsA肾中毒组,差异有非常显著意义(P＜0.01).对激素治疗敏感的排斥反应患者,sVCAM-1逐渐降至正常水平;耐激素的排斥反应患者应用ATG治疗后,sVCAM-1在排斥反应后1个月内仍维持在较高水平.CsA肾中毒组sVCAM-1水平无明显变化.结论:肾移植术后动态监测sVCAM-1水平的变化,有助于急性排斥反应的诊断、鉴别诊断及指导临床治疗.sVCAM-1可以作为肾移植术后急性排斥反应的免疫学监测指标.     

移植肾功能延迟恢复患者尿脱落细胞中穿孔素和粒酶B mRNA定量检测的意义

目的 探讨尿脱落细胞中穿孔素mRNA、粒酶B mRNA检测在移植肾功能延迟恢复(DGF)诊断中的应用价值. 方法 同种异体肾移植DGF患者24例.男15例,女9例.平均年龄37岁.移植肾活检病理分析病因为输尿管梗阻2例、静脉血栓1例、急性环孢素(CsA)中毒3例、急性肾小管坏死(ATN)7例、ATN合并临界改变2例、ATN合并急性排斥反应(AR)3例、AR 6例.移植术后1～14 d留取24例患者73份晨尿标本,应用竞争RT-PCR方法 对患者尿脱落细胞中穿孔素和粒酶B mRNA进行定量检测,应用SPSS13.0软件进行数据分析,mRNA水平用自然对数值表示.结果 24例患者尿脱落细胞中穿孔素和粒酶B mRNA水平在急性CsA中毒、ATN和其他组分别为(-0.76±0.35)、(-0.89±0.30)、(-0.90±0.15)fg/μg和(-0.53±0.22)、(-0.41±0.17)、(-0.73±0.23)fg/μg,组间厕两比较差异均无统计学意义(P>0.05);ATN合并AR组与单纯AR组分别为(1.20±0.39)、(11.13±0.33)fg/μg和(1.07±0.30)、(1.01±0.19)fg/μg,2组比较差异无统计学意义(P>0.05);ATN合并AR、单纯AR组与急性CsA中毒、ATN和其他组比较差异有统计学意义(P<0.001);2例ATN合并临界改变患者尿中穿孔素和粒酶B mRNA平均值分别为1.22、0.97 fg/μg,与ATN合并AR、单纯AR组相近. 结论 DGF患者尿脱落细胞中穿孔素和粒酶BmRNA水平检测有助于DGF的病因诊断,可作为临界改变是否需要进一步干预性治疗的指标之一.     

彩色超声在移植肾急性排斥反应和急性肾小管坏死鉴别中的应用

目的 :探讨彩色超声检查在肾移植术后急性排斥反应和急性肾小管坏死鉴别诊断中的应用价值。方法 :回顾性分析 5 86例临床资料完整的肾移植病例术后彩色超声检查结果并结合临床症状、生化指标及病理检查结果 ,分为正常对照组、急性排斥组 (AR组 )和急性肾小管坏死组 (ATN组 )进行分析。结果 :①AR组长径、皮质厚度明显大于对照组 (P <0 .0 5 ) ,ATN组与对照组之间差异无统计学意义。②AR组尚可见到肾锥体增大、膨隆、回声减低等二维声像图变化。③以动脉血流阻力指数 (RI)≥ 0 .7为标准 ,AR组和ATN组RI值明显高于对照组 ,AR组和ATN组之间差异无统计学意义 (P >0 .0 5 )。④经有效抗排斥治疗AR组RI值平均 1周左右先于二维声像变化恢复 ,二维声像图变化平均于 4周左右恢复 ,而ATN组RI值平均在 3周左右恢复正常。结论 :彩色超声在移植肾急性排斥反应和急性肾小管坏死鉴别中具有良好的应用价值。     

动态监测HLA Ⅰ类分子与降钙素原用于鉴别肾移植术后急性排斥反应与感染的价值

目的探讨动态监测患者肾移植术后外周血淋巴细胞表面人类白细胞抗原Ⅰ类分子(humanleukocyteantigenⅠ,HLAⅠ)及降钙素原(procalcitonin,PCT)水平用于鉴别急性排斥反应(AR)及感染的价值。方法根据术后临床表现、肾功能检查、影像学及移植肾穿刺活检结果将99例(102例次)肾移植受者分为3组,AR组18例次,感染组14例次,移植后正常组70例次,并选取齐鲁医院20名健康献血者作为正常对照组。采用流式细胞术(flowcytometry,FCM)检测研究对象外周血淋巴细胞表面HLAⅠ类分子表达水平;采用免疫荧光分析法定量检测研究对象血清PCT水平。结果肾移植受者术后发生AR或严重细菌感染时,淋巴细胞表面HLAⅠ类分子水平均明显升高,两组比较差异无统计学意义(P>0.05),但感染组的PCT阳性率明显高于AR组(P<0.01)。结论与监测外周血淋巴细胞表面HLAⅠ类分子水平相比,监测血清PCT水平变化在鉴别诊断肾移植术后AR与严重细菌感染方面更加敏感。     

可溶性CD44及其配体在肾移植患者急性排斥反应外周血中的表达及其意义

目的 探讨血清可溶性CD44分子及其配体在肾移植急性排斥反应时的变化及其意义.方法 收集123例肾移植患者外周血,酶联免疫吸附试验(ELISA)检测血清中sCD44水平,检测外周血透明质酸的水平.结果 13例围手术期急性排斥反应患者血清sCD44升高达(902.45±69.60)μg/L,和稳定组(355.70±82.01)μg/L比较,差异有统计学意义(P<0.05);15例出院后急性排斥反应患者血清sCD44升高至(1012.31±13.62)μg/L,和稳定组(315.38±26.72)μg/L比较,差异有统计学意义(P<0.05).结论 CD44分子与其配体相互作用在移植肾急性排斥反应中可能起到重要作用,有可能成为较好的早期诊断急性排斥的预测因子.     

肾移植术后监测血清、尿液和肾组织液中肿瘤坏死因子的临床意义

为探讨肾移植术后肿瘤坏死因子（ＴＮＦα）在移植肾排斥反应（ＡＲ）诊断与鉴别诊断中的意义，采用液相竞争放射免疫法动态监测６０例肾移植患者术后血清、尿液及肾组织液中ＴＮＦα水平的变化。结果：ＡＲ组ＴＮＦα水平在血清、尿液及肾组织液中均显著升高，以肾组织液中升高最明显，比临床症状的出现早１～２天；ＣｓＡ肾中毒组ＴＮＦα水平轻度升高，但无统计学意义；急性肾小管环死（ＡＴＮ）组肾组织液及尿液中ＴＮＦα水平均显著升高；急性感染组仅血清中ＴＮＦα水平显著升高。结论：动态监测血清、尿液和肾组织液中ＴＮＦα水平能较好地早期诊断和鉴别诊断ＡＲ、急性感染、ＣｓＡ肾中毒和ＡＴＮ。     

肾移植后测定血清可溶性细胞间粘附分子-1的临床意义

目的　探讨血清可溶性细胞间粘附分子 1(sICAM 1)在肾移植术后免疫学监测中的价值。方法　采用酶联免疫吸附法 (ELISA)动态监测 5 6例肾移植患者术后血清sICAM 1的变化。结果　肾移植患者术后发生排斥反应时 ,其sICAM 1水平 (390 .6 μg/L±91.0 μg/L)明显高于移植肾功能稳定者 (137.3μg/L±16 .8μg/L)和环孢素A(CsA)肾中毒者 (132 .7μg/L±2 4.8μg/L) ,差异有极显著性 (P <0 .0 1) ;抗排斥反应治疗有效后 ,sICAM 1逐渐降至正常水平 ;CsA肾中毒者的sICAM 1水平无明显变化。结论　肾移植术后动态监测患者血清sICAM 1水平的变化 ,有助于急性排斥反应的诊断、鉴别诊断及抗排斥治疗的疗效评价 ,可以作为肾移植术后急性排斥反应的免疫学监测指标。     

环孢素A在尸体肾移植中应用的体会

本文报告自1992年1月至1994年8月我院17例尸体肾移植应用CsA的体会。本组总的人/肾存活率为81.3%/75.o%。感染仍是肾移植患者死亡的主要原因。在环孢素时代,急性排斥反应(AR)的发生率下降,其表现较不典型且轻微。本组HLA配型与AR发生率的相关性不明显。本文对AR的诊断与治疗以及AR与CsA肾中毒的鉴别进行了探讨。     

重新评估可溶性白介素2受体检测诊断移植肾急性排异的意义

重新评估血、尿sIL-2R水平变化在肾移植中的临床价值。方法 观察108例同种异体肾移植患者血、尿sIL-2R水平,同时作移植肾活检监测肾组织内IL-2R表达阳性细胞。结果 急性排异组血、尿sIL-2R水平均明显高于无排异组、ATN组和CsA肾中毒组,但急性排异组与感染组之间并无显著性差异,临床上仍难以鉴别。急性排异组肾组织内IL-2R表达明显高于无排异组、ATN组、CsA肾中毒组和感染组。结论 (1)血、尿sIL-2R群体水平的变化对急性排异具有诊断价值。但是,单次测定血、尿sIL-2R结果受术后血尿、尿量、感染和肾功能等许多因素的影响;(2)肾组织内IL-2R的表达水平对急性排异的诊断比较可靠。     

肾移植后血清白细胞介素2、可溶性白细胞介素2受体和白细胞介素6的监测

动态监测６０例肾移植患者术后２个月内血清白细胞介素２（ＩＬ－２）、可溶性ＩＬ－２受体（ｓＩＬ－２Ｒ）和白细胞介素６（ＩＬ－６）的变化。结果发现发生急性排斥反应时，上述细胞因子的升高较临床诊断提早数天，并且显著高于环孢素Ａ肾中毒组；对甲泼尼龙敏感的排斥反应，抗排斥治疗数天后上述因子下降到排斥前水平。提示肾移植术后动态监测患者血清ＩＬ－２、ｓＩＬ－２Ｒ和ＩＬ－６有助于急性排斥反应的早期诊断、鉴别诊断、及时治疗和甲泼尼龙抗排斥的疗效评价。     

肾移植后尿中可溶性细胞间粘附分子-1浓度监测的临床意义

目的：评价肾移植后患者尿中可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）浓度变化的临床意义。方法：动态检测２０例肾移植患者术后２个月内尿中ｓＩＣＡＭ－１浓度的变化。结果：急性排斥反应（ＡＲ）时,ｓＩＣＡＭ－１的升高较临床诊断提早数天,并且显著高于环孢素Ａ肾中毒组;对甲基氢化泼尼松敏感的排斥反应,抗排斥治疗数天后ｓＩＣＡＭ－１下降到排斥前水平。结论：肾移植术后动态监测受者尿中ｓＩＣＡＭ－１浓度有助于ＡＲ     

ICAM-1和VCAM-1测定在肾移植急性排斥反应中的临床意义

目的探讨血清可溶性细胞间粘附分子１（ｓＩＣＡＭ１）和可溶性血管细胞粘附分子１（ｓＶＣＡＭ１）在肾移植急性排斥反应中的临床意义。方法采用酶联免疫吸附法（ＥＬＩＳＡ）动态监测５６例肾移植患者术后ｓＩＣＡＭ１和ｓＶＣＡＭ１水平的变化。结果肾移植患者术后ｓＩＣＡＭ１和ｓＶＣＡＭ１水平呈规律性变化,急性排斥反应组ｓＩＣＡＭ１为（３９０．６±９１．０）ｎｇ／ｍｌ,ｓＶＣＡＭ１为（１９５７．１±４０３．１）ｎｇ／ｍｌ,明显高于移植肾功能稳定组的（１３７．３±１６．８）ｎｇ／ｍｌ、（１１１８．４±２１０．４）ｎｇ／ｍｌ和ＣｓＡ肾中毒组的（１３２．７±２４．８）ｎｇ／ｍｌ、（１２８５．８±２７０．５）ｎｇ／ｍｌ,差异有非常显著性（Ｐ＜０．０１）。结论ｓＩＣＡＭ１和ｓＶＣＡＭ１可以作为肾移植术后急性排斥反应的免疫学监测指标。     

Evaluation of hepatocyte growth factor as a sensitive marker for early detection of acute renal allograft rejection

BACKGROUND: It has been shown that hepatocyte growth factor (HGF), besides its well-established hepatotrophic effect in liver regeneration, is involved in the regeneration of the kidney after injury. In the present study we investigated whether HGF can serve as a marker for detection of acute rejection in the early posttransplantation period. METHODS: HGF levels were determined in pre- and posttransplant sera (up to day 21) of 26 recipients with biopsy-proven acute rejection, 30 recipients with acute tubular necrosis (ATN), and 32 recipients without posttransplant complications. RESULTS: Although no association was found between pretransplant HGF and death-censored functional graft survival, receiver operating characteristic (ROC) curves demonstrated that HGF measured during the entire posttransplant study period, and especially on days 3 to 5, was a good marker for differentiating recipients who subsequently developed acute rejection from recipients with an uncomplicated course (P<0.0001, specificity 87%, sensitivity 84%). HGF measured from day 3 until day 21 posttransplantation, and especially on days 7 to 9, was also a sensitive marker for differentiating recipients with ATN from recipients with an uncomplicated course (P<0.0001). If considered in combination with sCD30, the diagnostic value of HGF was further improved. While 73% of samples from patients with impending rejection were positive for both HGF and sCD30, 94% of samples from nonrejecting patients were double-negative and none of the samples from this group fell into the double-positive category (P<0.0001). CONCLUSIONS: Our data suggest that HGF measured during the early posttransplant period might be a useful parameter for early detection of acute renal allograft rejection.     

Interleukin-6 and neopterin in renal transplant recipients: a longitudinal study

Serum and urine interleukin-6 (IL-6) levels and serum neopterin/creatinine ratios were longitudinally studied in 86 renal transplant recipients until 4 months after transplantation. During acute rejection and acute tubular necrosis (ATN), serum and urine IL-6 levels were elevated compared to during stable transplant function (P<0.001). During acute rejection, serum IL-6 levels increased at least 2 days before plasma creatinine started to rise (P<0.05), indicating its early involvement in the rejection process. During cytomegalovirus (CMV) disease, serum, but not urine, IL-6 levels were higher (P<0.01), and serum neopterin/creatinine values were higher than during stable transplant function, ATN, or acute rejection (P<0.01). No significant differences with stable transplant function occurred during cyclosporin A toxicity. Measurement of serum IL-6 provided a sensitivity of 84% and a specificity of 85% for the diagnosis of acute rejection episodes not coinciding with ATN. All cases of CMV disease could be diagnosed by measurement of serum neopterin/creatinine, which provided a specificity of 73%.     

Acute glomerular thrombosis with CsA treatment

Cyclosporin A (CsA) is used widely as an immunosuppressive in organ transplantation. Although it is highly effective, acute and chronic nephrotoxicity of CsA are of continuing concern. A case of acute glomerular thrombosis secondary to CsA therapy in a renal transplant recipient is described. The course of the accompanying acute renal failure and its reversal following discontinuation of CsA and therapy with intra-arterial streptokinase is outlined. CsA-induced capillary thrombosis is rare but has been described in renal transplant recipients as well as in hepatic and bone marrow transplantation. It may give rise to diagnostic confusion in the early days following renal transplantation, where it may mimic acute rejection. The etiology of CsA-induced glomerular capillary thrombosis remains speculative.     

肾移植术后血脂的变化对移植肾功能的影响

目的:探讨肾移植患者血脂代谢情况及其对移植肾功能的影响。方法:检测89例肾移植患者肾移植前、后的血脂水平,并与移植后1年内发生急性排斥反应及移植后1年时发生慢性移植肾功能不全的患者进行血清肌酐水平相关性分析。结果:与正常对照组比较,肾移植前、后的血清总胆固醇、低密度脂蛋白胆固醇的水平显著升高(P<0.01),甘油三酯、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇水平无显著差异。血载脂蛋白A1水平显著低于正常对照组(P<0.01)。移植前、后上述血脂水平无显著差异。移植前高胆固醇血症与急性排斥反应的发生存在相关性,高胆固醇血症对慢性移植肾功能不全患者血清肌酐水平升高存在影响。结论:肾移植患者血脂代谢紊乱明显不同于正常人群,高脂血症对急性排斥反应及慢性移植肾功能不全的发生具有不良影响。     

Acute Glomerular Thrombosis with CsA Treatment

Cyclosporin A (CsA) is used widely as an immunosuppressive in organ transplantation. Although it is highly effective, acute and chronic nephrotoxicity of CsA are of continuing concern. A case of acute glomerular thrombosis secondary to CsA therapy in a renal transplant recipient is described. The course of the accompanying acute renal failure and its reversal following discontinuation of CsA and therapy with intra-arterial streptokinase is outlined. CsA-induced capillary thrombosis is rare but has been described in renal transplant recipients as well as in hepatic and bone marrow transplantation. It may give rise to diagnostic confusion in the early days following renal transplantation, where it may mimic acute rejection. The etiology of CsA-induced glomerular capillary thrombosis remains speculative.