肺移植术后受者T细胞亚群和IL-6水平的动态变化1例并文献分析

目的：探讨肺移植术后患者T细胞亚群和白介素-6（IL-6）水平的动态变化。方法：用流式细胞仪测定1例异体肺移植患者不同时间外周血T细胞亚群细胞的百分率和CD4／CD8比值，以及用酶标ELISA法测定其不同时间外周血IL-6水平，术后监测T细胞亚群至50d，IL-6至96d，以患者术前结果作对照。结果：排异反应前CD3、CD4、CD8、NK、IL-6随着免疫抑制药应用逐渐降低，以2～4d为最低，CD4／CD8比值虽有降低，但有波动，术后第6d发生排异反应，CD3、CD4、CD8、NK迅速升高，IL-6迟于发生排异反应2d后出现高峰，予以甲强龙冲击治疗，CD3、CD4、CD8、NK并未降低到发生排异前水平，CD3、CD8、NK维持在稍低于正常的水平，CD4接近正常，CD4／CD8比值大多高于术前，IL-6也有所下降，但2个月后发生肺部霉菌等感染，IL-6也出现一个高峰。结论：外周血CD3、CD4、CD8、NK、CIN／CD8的检测，对于肺移植患者早期急性排异反应的预测有一定价值，在发生排异反应经甲强龙冲击治疗后其水平的变化与患者稳定的病情相一致，而IL-6的变化特异性不高。

The Dynamic Changes of T Cell Subsets and IL-6 in Peripheral Blood of a Lung Allograft Recipient: a Case Report

Objective:To study dynamic changes of T cell subsets and IL-6 in peripheral blood of a lung allograft recipient. Methods: The levels of CD3,CE4,CD8,NK T cells and CD4/CD8 in perpheral blood of a lung allograft recipient in different periods were examined by flow cytometry and the level of IL-6 in perpheral blood of the lung allograft recipient in different periods was examined by ELISA. T cell subsets were tested after transplantation for 50 days and IL-6 was tested after transplantation for % days. The levels of CD3,CD4,CD8,NK T cells and CD4/CD6 in perpheral blood before transplantation were examined as the control group. Results: The levels of CD3,CD4, CD8, NK, IL-6 began to decrease with the application of immu-nosuppression drug before rejection. From 2 to 4 days after transplantation, the levels were the lowest. Ratio of CD4/CD8 fluctuated although it decreased. The acute lung allograft rejection occurred 6 days after operation. The levels of CD3,CD4, CD8,NK T cells were quickly risen,but they didn't degrade to the lever before rejection although performed by stosstheraphy with urbasoa The expression of IL-6 descended, but it displayed a peak when infection occurred such as pulmonary mycetes 2 months later. Conclusion: To detect the levels of CD3,CD4,CD8,NK T cells and CD4/CD8 in perpheral blood of a lung allograft recipient would have value in predicting acute rejection in earlier period. Their changes by stosstheraphy with urbason are consistent with patienfs stable condition while the change of IL-6 has a lower specificity.