联合检测血清HLA-G5和sCD30水平对评价肾移植受者免疫状态的价值

目的 研究肾移植受者血清人类白细胞抗原G5(HLA-G5)、可溶性CD30(sCD30)的表达与移植肾功能的关系,以及联合两者评价肾移植受者免疫状态的最佳诊断阈值、敏感度及特异度.方法 选取2002年1月至2008年11月西安交通大学医学院第一附属医院肾病中心接受同种异体肾移植手术受者66例,其中38例移植肾功能正常,15例为急性排斥反应,13例为慢性排斥反应.检测所有受者血清HLA-G5、sCD30的表达水平;应用受试者工作特征曲线分析HLA-G5联合sCD30评价移植术后1年内及术后1年以上不同免疫状态的最佳临界值、敏感度和特异度.结果 HLA-G5水平与血肌酐水平相关(r=-0.493,P＜0.01),sCD30水平与血肌酐水平相关(r=0.691,P＜0.01).术后1年内,当HLA-G5临界值取82μg/L,sCD30 临界值取12.2μg/L时,评价肾移植受者免疫状态的敏感度为7 8.6%,特异度为85.7%;术后1年以上,当HLA-G5临界值取141μg/L,sCD30临界值取10.3 μg/L时,评价肾移植受者免疫状态的敏感度为92.3%,特异度为84.6%.结论 血清HLA-G5联合sCD30可作为反映肾移植受者免疫状态简便而有效的临床指标.

Evaluation of immune status of kidney transplant recipients by combined HLA-G5 and sCD30

Objective To study the relationship between the expression of serum human leucocyte antigen-G5 (HLA-G5)/soluble CD30 (sCD30) and the fuction of renal graft in kidney transplant recipients and investigate the immune status of recipients with combined HLA-G5 and sCD30. Methods From January 2002 to November 2008, a total of 66 kidney transplant recipients in our centre were selected as subjects and divided into three groups: stable function of renal graft (n =38), acute rejection (n= 15) and chronic rejection (n = 13). The expressions of serum HLA-G5 and sCD30 were detected. There were two different immune conditions with acute/chronic allograft rejection and normal renal graft in kidney transplant recipients as evaluated by combined HLA-G5 and sCD30. The sensitivity, specificity and critical value of the method were analyzed by the curve of receiver operating characteristic. Results The levels of HLA-G5 and sCD30 were significantly correlated with serum creatinine ( r = - 0.493, 0.691, both P ＜ 0. 01 ). Within the first year post-transplantation, the sensitivity was 75. 6% and the specificity 85. 7% when HLA-G5critical value 82 μg/L and sCD30 critical value 12.2 μg/L. After one year post-transplantation: the sensitivity was 92. 3% and the specificity 84. 6% when HLA-G5 critical value 141 μg/L and sCD30 critical value 10. 3μg/L. Conclusion The immune state of recipients are evaluated by combine HLA-G5 and sCD30 which may be a simple and valid method.