移植肾急性排斥与移植前后血清细胞因子表达的变化

背景：目前异体器官移植后细胞因子变化己经有较多的报道,但有关细胞因子在肾移植患者中的动态变化规律及其与移植急性排斥反应的关系鲜有报道。目的：观察肾移植受者移植前后血清细胞因子表达变化,并探讨其与移植肾急性排斥的关系。方法：选择2008年9月至2011年9月武警后勤学院附属医院收治的接受肾移植患者48例,均为首次肾移植,分为肾功能稳定组和急性排斥反应组。另选择健康体检者30人为对照组。结果与结论：肾功能稳定组、急性排斥反应组移植前1 d血清肿瘤坏死因子α、白细胞介素6、白细胞介素8水平与对照组相比差异无显著性意义(P > 0.05)。肾功能稳定组血清3种细胞因子水平均于移植后第1天即开始逐渐升高,在3 d时显著升高(P < 0.05),5 d时开始下降,7 d下降显著(P < 0.05),14 d左右趋于降至移植前水平,21-28 d表达稳定在移植前水平。急性排斥反应组血清3种细胞因子水平于移植后第1天即显著升高(P < 0.05),7-14 d维持在高水平 (P < 0.05),21-28 d稳定下降,但仍明显高于移植前(P < 0.05)。相同时间段,急性排斥反应组血清3种细胞因子水平均明显高于肾功能稳定组(P < 0.05)。提示移植后血清肿瘤坏死因子α、白细胞介素6、白细胞介素8动态水平变化在一定程度上反映肾移植受者的免疫反应状态,可作为辅助早期诊断急性排斥反应的免疫生物学指标。

Relationship between acute rejection and expression of serum cytokines before and after renal transplantation

BACKGROUND:At present, there are many reports on the changes of cytokines after allogenic organ transplantation, but the reports on the dynamic expression of cytokines in renal transplantation patients and the relationship with acute rejection after renal transplantation are rare.OBJECTIVE:To observe the changes of serum cytokines expression before and after renal transplantation and to investigate the relationship with acute rejection.METHODS:Forty-eight renal transplantation recipients were chosen from the Affiliate Hospital of Logistics College of the Chinese People’s Armed Police Forces during September 2008 to September 2011, and all the patients were in the first renal transplantation. The patients were divided into acute rejection group and stable renal function group. Another 30 health people were selected as control group.RESULTS AND CONCLUSION:There was no significant difference in serum levels of tumor necrosis factor-α, interleukin 6 and interleukin 8 between the stable renal function group, acute rejection group and the control group at 1 day after renal transplantation (P > 0.05). The serum levels of tumor necrosis factor-α, interleukin 6 and interleukin 8 in the stable renal function group were gradually increased at 1 day after renal transplantation, significantly increased at 3 days after transplantation (P < 0.05); then began to decrease at 5 days after transplantation, significantly decreased at 7 days after transplantation (P < 0.05), and decreased to the pre-transplantation point at 14 days. The serum levels of tumor necrosis factor-α, interleukin 6 and interleukin 8 in the stable renal function group were kept in the levels before transplantation from 21 days to 28 days. In the acute rejection group, the serum levels of tumor necrosis factor-α, interleukin 6 and interleukin 8 were increased significantly at 1 day after transplantation (P < 0.05), kept the high levels from 7 days to 14 days (P < 0.05), then decreased from 21 days to 28 days, but the levels were significantly higher than those before transplantation (P < 0.05). At the same time point, the serum levels of tumor necrosis factor-α, interleukin 6 and interleukin 8 in the acute rejection group were significantly higher than those in the stable renal function group (P < 0.05). The dynamic expression of serum tumor necrosis factor-α, interleukin 6 and interleukin 8 can estimate the immune function of renal transplantation recipients and can be used as the immunobiology indicators for the early diagnosis of acute rejection after renal transplantation.