肝移植术后趋化因子Mig、IP10、ITAC的变化对早期诊断急性排斥反应的意义

目的:观察趋化因子Mig、IP10、ITAC在肝移植术后的变化,探讨其对肝移植术后急性排斥早期诊断的意义.方法:2005年4～9月30例肝移植患者,根据临床表现及病理学检查分为急性排斥组(AR,n=9)(排除3例术后感染患者),非急性排斥组(NAR,n=18).检测患者术前1 d及术后1、3、5、7 d血清中趋化因子Mig、IP10、ITAC的表达,并与同期住院的肝硬化或肝癌患者(肝癌肝硬化组,n=16)以及健康体检者(正常对照组,n=16)进行比较.AR组患者分别于确诊当天以及经激素冲击治疗后3、7 d检测血清中3种趋化因子的表达,并分析确诊当天3种趋化因子表达与肝脏穿刺活检Banff排斥活动指数(RAI)的相关性.结果:肝移植术前1 d AR组、NAR组患者血清Mig、IP10、ITAC表达与肝癌肝硬化组无明显差异,但高于正常对照组(P<0.01).肝移植术后3 d,AR和NAR组Mig、IP10、ITAC的表达水平均有上升,高于术前1 d的表达(P<0.05).AR组9例患者分别在术后11、12和14 d确诊AR发生,术后各时间点患者血清Mig、IP10、ITAC表达明显高于NAR组(P<0.01);确诊AR当天Mig、IP10、ITAC的表达与RAI呈正相关(r=0.88、0.94、0.80).与确诊AR当天相比,经冲击治疗逆转后,3种趋化因子的表达也相应下降(P<0.01).结论:肝移植术后血清中趋化因子Mig、IP10、ITAC的表达可作为早期诊断急性排斥反应辅助特异、敏感的指标.

Dynamic changes of chemokines Mig, IP10, and ITAC in early diagnosis of acute rejection after liver transplantation

Objective:To investigate the dynamic expression of chemokines Mig,IP10,and ITAC after liver transplantation and to study its role in early diagnosis of acute rejection in humans.Methods: Thirty patients receiving liver transplantation(April 2005 to September 2005) were divided into acute rejection(AR) group(n=9) and non-acute rejection(NAR) group(n=18) based on the clinical symptoms and pathological examination.Three patients were excluded due to post-operation infection.The chemokines expression was determined in all patients 1 day before and day 1,3,5,7 after transplantation.Sixteen patients with liver cirrhosis(cancer) and 16 normal adults were also examined as control in this study.Patients in AR group received pulse glucocorticoid treatment from the onset of AR and the expression of chemokines was determined on the day of AR diagnosis and day 3,7 after glucocorticoid treatment.The relationship between Banff rejection activity index(RAI) and 3 chemokines expression on the day of AR onset was analyzed.Results: Chemokines expression was not significantly different between transplantation group and liver cirrhosis(cancer) group one day before transplantation;however,it was significantly higher than that of the normal control group(P<0.01).The expression of Mig,IP10 and ITAC was increased markedly in AR and NAR group day 3 after transplantation(P<0.05).AR was confirmed in 9 patients on day 11,12 and 14 after transplantation.The serum contents of Mig,IP10 and ITAC in AR group were higher than those in NAR group at all defined time points after transplantation.There was a positive relationship between RAI and the expression of Mig,IP10 and ITAC on the day of AR onset(r=0.88,0.94,0.80,respectively).In AR patients,the expression of Mig,IP10 and ITAC decreased after pulse treatment with glucocorticoid(P<0.01).Conclusion: Serum level of Mig,IP10 and ITAC can serve as a sensitive,specific marker for early predication of AR in liver transplant patients.