肾移植后贫血患者早期应用促红细胞生成素的临床效果分析

目的 研究肾移植后贫血患者早期应用促红细胞生成素(EPO)的效果。方法 回顾性分析在苏州大学附属第一医院行肾移植手术的患者，其中术后使用促红细胞生成素治疗者为EPO组，未予以EPO治疗的为常规组。排除术后发生肾功能延迟恢复的受者，对余患者进一步统计分析，比较两组的一般资料、实验室资料和随访情况，观察药物不良反应。结果 EPO组术后第2周血红蛋白(P=0.026)、红细胞计数(P=0.038)、血细胞比容(P=0.011)均高于常规组，且术后血肌酐水平较常规组更低(P=0.001)。自术后第1周，EPO组网织红细胞计数显著高于常规组(P<0.01)。分析血红蛋白与血肌酐的相关性，EPO组在术后第1周(r=-0.375,P=0.010)、第2周(r=-0.386,P=0.008)均呈负相关。用药期间，除6例患者出现一过性血钾升高，予对症处理后恢复正常，余未见明显药物不良反应。结论 肾移植患者术后早期持续应用EPO,可明显改善肾移植患者的贫血状况，进一步促进移植肾功能的恢复。     

慢性前列腺炎患者血清中B7-H3分子的表达及其临床意义

目的检测慢性前列腺炎（CP）患者血清中是否存在可溶性B7-H3（sB7-H3）,并探讨其临床意义。方法采用酶联免疫吸附法（ELISA）测定79例CP患者血清中sB7-H3水平,并以11名健康男性作为对照。按美国国立卫生研究院（NIH）分类法将79例CP患者分为3型：Ⅱ型9例,ⅢA型21例,ⅢB型49例。患者症状轻重程度均通过慢性前列腺炎症状评分表（CPSI）判定。分析各组间血清中sB7-H3水平差异,以及与前列腺液（EPS）中白细胞（WBC）、卵磷脂小体（SPL）计数间的关系,并进一步分析其与CPSI评分之间的关系。结果对照组与CP组血清中sB7-H3水平分别为（3.685±1.881）ng/ml和（3.619±1.514）ng/ml,两者差异无统计学意义（P〉0.05）。但Ⅱ型组（2.305±0.732 ng/ml）明显低于ⅢA型（3.670±0.771 ng/ml）及ⅢB型（3.839±1.736 ng/ml）组（均P〈0.01）。从CP患者中诊断Ⅱ型及Ⅲ型患者的ROC曲线下面积为0.814,取最佳诊断点为2.943 ng/ml时,灵敏度为71.4%,特异度为88.9%。血清sB7-H3与CPSI评分、WBC、SPL间无相关关系（P〉0.05）。结论血清sB7-H3检测可能有助于区分Ⅱ型及Ⅲ型前列腺炎。     

肾移植患者血清中可溶性B7-H3水平的变化及其临床意义

目的 检测肾移植患者移植前后血清中可溶性B7-H3(sB7-H3)水平变化,并探讨其临床意义.方法 34例肾移植患者于移植前及移植后3、6、12个月采集外周血,用酶联免疫吸附试验(ELISA)检测血清中的sB7-H3,取11例健康志愿者为正常对照.用Luminex检测人白细胞抗原(HLA)和主要组织相容性Ⅰ类相关链A位点(MICA)抗体并分为术前抗体阳性组及阴性组.随访组根据术后1年内基本情况分为肾功能稳定组和不稳定组.结果 肾移植组术前血清sB7-H3水平[(27.10±13.61)μg/L,n=34]高于正常对照组[(11.61±3.77)μg/L,n=11],两组比较差异有统计学意义(P＜0.01),且术前抗体阳性组血清sB7-H3水平高于阴性组[(34.96±17.37)μg/L,n=11比(23.34±9.75)μg/L,n=23,P＜0.05].肾移植术后肾功能稳定组各时间点血清sB7-H3水平与正常对照组比较差异无统计学意义(P＞0.05),肾功能不稳定组未排斥时血清sB7-H3和肌酐(Cr)水平与正常对照组比较差异亦无统计学意义(P＞0.05),而排斥时其血清sB7-H3水平[(20.63±4.28)μg/L,n=12;(18.95±2.98)μg/L,n=6;(28.36±19.83)μg/L,n=10]和Cr均明显升高,与肾功能稳定组及正常对照组比较差异有统计学意义(P＜0.01).结论 慢性肾炎患者血清sB7-H3水平增高,且术前抗体阳性组增高更明显;肾移植术后血清sB7-H3水平与肾功能变化一致.术后监测sB7-H3动态变化,可间接了解患者机体免疫状态,对肾移植术后的疗效观察和预后判断有参考价值.

Abstract：

Objective To detect the serum soluble B7-H3 (sB7-H3) in patients before and after renal transplantation, and to investigate the clinical significance. Methods The serum level of sB7-H3 in 34 patients were determined before and 3, 6, 12 months after renal transplantation. Besides, 11 health adults were elected as controls. These 34 patients were divided into two groups according to HLA and/or MICA antibodies using Luminex before operation. After transplantation, all the patients were divided into two groups according to their conditions; group Ⅰ with rejection; group S with stable renal function and no rejection. Results The serum level of sB7-H3 in all 34 patients before operation was significantly higher than health controls [(27. 10 ± 13. 61) μg/L,n = 34 vs (11.61 ±3.77) μg/L,n = 11 ,P ＜0. 01], and significantly higher in patients with antibodies than in those without before operation [(34. 96 ± 17. 37) (μ/L, n = 11 vs (23. 34 ± 9. 75) (μg/L, n = 23, P ＜ 0. 05]. There was no significant difference in the serum level of sB7-H3 between control group and S group after operation (P ＞0. 05). In group Ⅰ, the serum level of sB7-H3 was increased obviously when rejection occurred [(20. 63 ±4. 28) μg/L,n = 12; (18. 95 ±2.98) μg/L,n=6; (28.36 ±19. 83) μg/L,n = 10] , as compared with group S and control group (P＜0. 01), while at the time without rejection, there was no difference among them (P ＞0. 05). Conclusion Monitoring serum sB7-H3 after renal transplantation would be clinically useful in indicating therapeutic effect and outcome of the patients.