摘要
目的:探讨肝移植术后测定CD4^+T淋巴细胞内ATP水平的临床意义。方法:选取郑州人民医院2016年2月-2019年2月收治的78例肝移植患者作为肝移植组,术后3 d和1个月后取静脉血,测定CD4^+T淋巴细胞内ATP水平。根据患者术后感染情况将肝移植患者分为感染组46例与非感染组32例;选取同期入院体检正常的78例健康者作为对照。根据CD4^+T淋巴细胞内ATP水平将各组患者分为低免疫应答状态(ATP <225μg/L)、正常免疫应答状态(ATP为225~525μg/L)和高免疫应答状态(ATP> 525μg/L)。比较各组CD4^+T淋巴细胞内ATP水平以及低免疫应答、正常免疫应答患者构成比。结果:肝移植组患者低免疫应答者构成比(88.46%,69/78例)显著高于健康组(0,0/78例),正常免疫应答者(11.54%,9/78例)显著低于健康组(100.00%,78/78例),肝移植组CD4^+T淋巴细胞内ATP水平[(168.34±46.37)μg/L]显著低于健康组[(286.52±87.39)μg/L],差异有统计学意义(P <0.001)。肝移植组患者中感染患者低免疫应答构成比(97.83%,45/46例)高于非感染组(71.88%,23/32例),ATP水平[(152.34±43.28)μg/L]显著低于非感染组[(236.26±79.35)μg/L,P <0.001]。ATP值<152μg/L时,患者感染风险增加,OR=11.2,97.48%可信区间为4.2~33.1(P <0.05);ATP值<152μg/L时术后感染患者敏感性为87.76%,特异性为72.49%。结论:肝移植患者术后CD4^+T淋巴细胞内ATP水平可反映患者免疫反应状态,可作为患者术后感染的诊断指标之一,并且可指导术后免疫抑制剂的使用。
Objective:To investigate the clinical significance of determination of adenosine triphosphate(ATP)level in CD4^+T lymphocyte after liver transplantation.Methods:Seventy-eight patients with liver transplantation were enrolled in present study and set as liver transplantation group,who were admitted to the People's Hospital of Zhengzhou from Feb.2016 to Feb.2019.And 78 healthy persons admitted for a medical examination during the same period were selected as the control group.Samples of venous blood were collected from the subjects for detection of ATP level in CD4^+T lymphocyte.Subjects in liver transplantation group were divided into infection group(46 cases)and noninfection group(32 cases)according to the infection status after liver transplantation.According to the ATP level in CD4^+T lymphocyte,subjects were considered to be in low immune response status(ATP<225μg/L),in normal immune response status(225μg/L≤ATP≤525μg/L)or in high immune response status(ATP>525μg/L).The ATP level in CD4^+T lymphocyte in each group and the rate of patients with low immune response and normal immune response were compared.Results:The rate of patients with low immune response was obviously higher in liver transplantation group(69/78,88.46%)than in control group(0/78,0),and with normal immune response was obviously lower in liver transplantation group(9/78,11.54%)than in control group(78/78,100.00%).The ATP level in CD4^+T lymphocyte was markedly lower in liver transplantation group[(168.34±46.37)μg/L]than in control group[(286.52±87.39)μg/L]with statistical significance(P<0.001).In patients with liver transplantation,the rate of low immune response was higher in infection group(45/46,97.83%)than in non-infection group(23/32,71.88%);the ATP level in CD4^+T lymphocyte was lower in infection group[(152.34±43.28)μg/L]than in non-infection group[(236.26±79.35)μg/L,P<0.001].When ATP value<152μg/L,the risk of infection increased,OR=11.2,the confidence interval of 97.48%was 4.2~33.1(P<0.05),and the sensitivity of postoperative infection was 87.76%and the specificity was 72.49%when the ATP value<152μg/L.Conclusions:In patients with liver transplantation,the ATP level in CD4^+T lymphocytes can reflect the immune response status,which can be used as one of the diagnostic criteria of postoperative infection,and can guide the use of postoperative immunosuppressants.
作者
赵云峰
苗书斋
孙一博
慎浩鑫
曲青山
Zhao Yunfeng;Miao Shuzhai;Sun Yibo;Shen Haoxin;Qu Qingshan(Organ Transplantation Center,the People’s Hospital of Zhengzhou,Zhengzhou Henan,450003,China)
出处
《感染．炎症．修复》
2019年第3期185-188,共4页
Infection Inflammation Repair
关键词
CD4^+T淋巴细胞
三磷酸腺苷
肝移植
感染
CD4^+T lymphocytes
Adenosine triphosphate
Liver transplantation
Infection
