肾移植受者术前血清可溶性CD30水平对急性排斥的影响

目的 研究术前血清可溶性CD30(sCD30)水平对肾移植受者术后6个月内急性排斥及排斥类型的预测作用。方法 共纳入自1998年12月至2003年8月在本中心行同种异体肾移植手术且存有术前血标本的707例受者。 回顾性总结该组受者术后6个月内急性排斥的发生情况及其它临床资料,同时选取健康对照40例。用sCD30 ELISA 试剂盒复孔检测肾移植受者术前和健康对照血清sCD30水平。根据术前sCD30水平将肾移植受者分为低sCD30组、中间sCD30组和高sCD30组。结果 肾移植组术前sCD30水平明显高于健康对照。血管性、细胞性排斥及临界改变的发生率随着sCD30水平的升高而升高(P均 < 0.05),但低、中、高sCD30 3组急性排斥逆转率却分别为100%、90.6%和78.6%,低sCD30组、中间sCD30组与高sCD30组比较差异均有统计学意义(P均 < 0.05)。血管性排斥、细胞性排斥、临界改变和临床排斥的sCD30水平[(198.95±76.09)、(165.89±44.56)、(172.94±74.22)和(161.23±64.87) U/ml]和未排斥组[(133.76±61.95) U/ml]比较,差异均有统计学意义(P均 < 0.01)。多因素logistic回归分析显示,高sCD30、群体反应性抗体(PRA)阳性和巨细胞病毒(CMV)抗原阳性均为急性排斥的危险因素,优势比分别为2.683、2.384和2.065。结论 术前高sCD30水平预示术后急性排斥发生率的增高。

Acute rejection episodic outcomes resulted from pre-transplant serum level of the soluble CD30 in kidney transplant recipients

Objective To investigate the influence of pretransplant soluble CD30 (sCD30) level on acute rejection episode in kidney transplant recipients. Methods This retrospective study included 707 allograft kidney transplant recipients from Dec 1998 to Aug 2003 and 40 healthy as controls. The recipients′ pretransplant serum sample and post-transplant clinical data including acute rejection episodes were collected. The recipients were divided into low, median, high level sCD30 group according to their pretransplant sCD30 levels. sCD30 levels of the recipients and the controls were determined by ELISA assay in duplicate. Results Kidney graft recipients had a significant increased pretransplant serum sCD30 content as comprared to healthy controls(P < 0.01). The incidences of vascular rejection, cellular rejection and bordline increased positively with the pre-transplant sCD30 level (all P < 0.05). But the inversion rates of rejection were 100%, 90.6% and 78.6 in the low,median and high sCD30 groups,respectively. The sCD30 levels of vascular, cellular, bordline and clinical rejection groups were (198.95±76.09),(165.89±44.56),(172.94±74.22) and (161.23±64.87) U/ml,respectively, which were all higher than those of non-rejection group (all P < 0.05). The sCD30 values were the highest in the vascular rejection. Multifactors logistic regression analysis indicated that the sCD30, PRA and CMV antigen were risk factors of acute rejection with odds ratio of 2.683, 2.384 and 2.065, respectively. Conclusion Pre-transplant serum level of sCD30 is a sensitive prognostic and risk factor for acute rejections.