摘要
目的探讨CD4＋T淋巴细胞内三磷酸腺苷（ATP）含量检测法（ImmuKnow法）免疫细胞功能测定在肝移植后肾功能不全受者个体化免疫抑制治疗中的应用。方法2009年1月至2011年12月间接受肝移植，术后肝功能恢复正常、稳定，但术后6个月以后肾功能持续异常的成人受者20例。定期监测其ImmuKnowATP值，结合血他克莫司浓度谷值结果指导受者免疫抑制剂应用。观察经上述治疗后受者肾功能的变化。结果20例肝移植后随访15-54个月，接受ImmuKnow检测61次，ATP值为33-943μg／L，中位数为282ug／L，四分位距为267ug／L。移植前患者血肌酐中位数为151．8μmol／L，四分位距为44．9btmol／L；随访期末受者血肌酐为中位数为114．9μmol／L，四分位距为35．3μmol／L。肾小球滤过率（eGFR）由0．746ml／s（中位数，四分位距为0．025ml／s）提高到1．005ml／s（中位数，四分位距为0．454ml／s）。Immu KnowATP值与受者白细胞计数呈线性相关（Spearman相关系数=0．429，P：0．001），而与患者年龄、术前原发病、术后时间、血他克莫司浓度谷值、淋巴细胞计数、CD3＋T淋巴细胞计数、CD4＋T淋巴细胞计数及CD4＋淋巴细胞／CD8＋淋巴细胞值等均无线性相关（P〉0．05）。结论ImmuKnow免疫细胞功能测定可用于肝移植后肾功能不全受者个体化免疫抑制治疗的监测，具有一定的临床应用价值。
Objective To assess the clinical application of Cylex ImmuKnow assay in patients with renal dysfunction after liver transplantation for individualized immunosuppressive therapy. Method Twenty adult patients undergoing liver transplant between January 2009 and December 2011 received regular ImmuKnow assay monitoring combined with determination of serum tacrolimus trough concentration to guide immunosuppressive regimens, all of whom showed sustained renal dysfunction 6 months after transplant with normal and stable liver function. Clinical data were collected to observe the changes of renal function in those patients after treatment. Results The recipients were followed- up for 15-54 months, received ImmuKnow assay 61 times and the results fluctuated 33-943μg/L [median 282μg/L, interquartile range （IQR） 267 μg/L]. After ImmuKnow monitoring, serum creatinine level in patients was decreased significantly from median 151.8 μmol/L with IQR 44. 9 μmol/L to median 114. 9 μmol/L with IQR 35.3μmol/L （Z = - 3. 845, P = 0. 000）, and estimated glomerular filtration rate （eGFR） was increased significantly from median 0. 746 mL/s with IQR 0. 025 mL/s to median 1. 005 mL/s with IQR 0. 454 mL/s （Z = - 3. 771, P = 0. 000）. ImmuKnow results showed a linear correlation with the white blood cell count in patients （Spearman correlation coefficient r = 0. 429, P = 0. 001）, but no linear correlation with the patients＇ age, primary disease before transplantation, postoperative time, serum tacrolimus trough concentration, lymphocyte count, CD3＋ T lymphocyte count, CD4＋ T lymphocyte count or CD4＋/CD8＋ T lymphocyte ratio （P〈0. 05）. Conclusion Cylex ImmuKnow assay can be applied in patients with renal dysfunction after liver transplantation for individualized imrnunosuppressive therapy monitoring, which is of certain clinical value.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2013年第11期661-665,共5页
Chinese Journal of Organ Transplantation
基金
国家高技术研究发展计划（863计划）（2012AA021000）
国家自然科学基金面上项目（81170444）
天津市应用基础与前沿技术研究计划（11JCZDJC27800）
天津市卫生局科技基金（09KR05,10KG101）
关键词
肝移植
肾功能不全
腺苷三磷酸
免疫抑制
Liver transplantation
Renal dysfunction
Adenosine triphosphate
Imrnunosuppression
