肾移植患者手术前后外周血CD4＋T淋巴细胞IL-18Rα的表达及意义

目的：探讨外周血CD4^＋T淋巴细胞IL-18Rα表达在肾移植急性排斥反应中的作用及临床意义。方法：采用分别检测肾移植患者手术前、手术后1w及2w外周血CD4^＋T淋巴细胞IL-18Rα表达量，并进行比较分析。结果：肾移植患者手术前外周血CD4^＋T淋巴细胞IL-18Rα表达量明显高于正常对照组（P〈0．01）。急性排斥组手术后1w、2w与手术前比较外周血CD4^＋T淋巴细胞IL-18Rα表达量明显增加（P〈0．01）。稳定组手术后1w与手术前比较外周血CD4^＋T淋巴细胞IL-18Rα表达量明显增加（P〈0．01），手术后2w则下降至手术前水平（P〉0．05）。结论：肾移植患者手术前、手术后存在Th1／Th2失衡，表现为Th1优势应答。肾移植手术前后监测外周血CD4^＋T淋巴细胞IL-18Rα表达量变化对于判断急性排斥反应有一定临床意义。

Significance of Changes of Expression of IL-18Rα on CD4+T Cells in Patients After Renal Transplantation

Objective To study the clinical significance of changes of expression of IL-18Rα on CD4^＋ cells in patients after renal transplantation. Methods Expressions of IL-18Rα on peripheral CD4^ ＋ cells were determined with flow - cytometry in 33 patients after renal transplantation dynamically on the day before operation, d7 and d14 as well as once in 30 controls. Results The expressions of IL-18Rα on CD4^ ＋ ceils in the patients before operation were significantly higher than those in the controls （ P 〈 0.01 ）. Post - operatively, both on d7 and d14, the levels of expression in the six patients with acute rejection were significantly higher than those before operation （P 〈0.01 ）. However, in the 27 patients without acute rejection, the expression levels were significantly higher than the preoperative levels only on d7 （P 〈 0.01 ）, but dropped to preoperative levels by d14 （ P 〉 0.05 ）. Conclusion Thl type immune - response was dominant in the patients as shown by the pre - operative higher - than - control levels of IL-18Rα expression. persistent increased expression of IL-18Rα post- operatively by d14 might indicate the development of rejection.