尿IL一6监测对肾移植术后急性排斥反应的诊断价值

目的 探讨肾移植患者手术前后尿液中IL-6的变化及临床意义.方法 采用ELISA法,动态监测患者移植手术前后尿液中IL-6的浓度.结果 尿液中IL-6的浓度在肾移植术后第1天明显升高.急性排斥反应前1～2天尿液中IL-6的浓度有不同程度的升高,抗排斥治疗后迅速下降.结论 动态监测尿IL-6是早期诊断肾移植术后急性排斥反应的一个较好的参考指标.     

尿IL-6监测对肾移植术后急性排斥反应的诊断价值

目的探讨肾移植患者手术前后尿液中IL-6的变化及临床意义。方法采用ELISA法,动态监测患者移植手术前后尿液中IL-6的浓度。结果尿液中IL-6的浓度在肾移植术后第1天明显升高。急性排斥反应前1～2天尿液中IL-6的浓度有不同程度的升高,抗排斥治疗后迅速下降。结论动态监测尿IL-6是早期诊断肾移植术后急性排斥反应的一个较好的参考指标。     

超敏C-反应蛋白对肾移植术后急性排斥反应的诊断价值

目的探讨肾移植术后受者血清中超敏C-反应蛋白（hsCRP）在急性排斥反应中的变化及临床意义。方法回顾性分析51例肾移植受者术前、术后1个月内及急性排斥反应、感染发生时血清hsCRP和肌酐（Cr）的浓度变化。并根据临床表现、检验结果及影像学表现将受者分成肾功能稳定组、急性排斥组和感染组。结果 46例受者hsCRP于肾移植术后1～2 d内迅速升高并达峰值,7 d内降至正常范围（0～3 mg/L）。急性排斥组hsCRP浓度显著高于肾功能稳定组（P〈0.01）。急性排斥反应发生时,hsCRP在Cr升高前1～2 d就开始升高,经甲基强的松龙冲击治疗有效后hsCRP迅速下降。感染组hsCRP浓度显著高于肾功能稳定组（P〈0.01）,而Cr水平同肾功能稳定组比较,差异无统计学意义（P〉0.05）。结论监测hsCRP有助于早期诊断肾移植急性排斥反应,可对免疫抑制剂治疗的有效性作出有益的提示,hsCRP可同Cr一起作为监测移植肾功能的指标。     

降钙素原在肾移植术后并发细菌感染中的临床应用

目的 :探讨降钙素原 (PCT)在肾移植术后并发细菌感染诊断中的临床意义。方法 :采用免疫层析法检测肾移植患者血清中的PCT浓度。结果 :肾移植术后并发细菌感染时患者血清中PCT浓度增高 ,发生急性排斥反应时不增高 ,二者之间的差异有显著性意义 (P <0 .0 1) ;发生急性排斥反应患者与无并发症患者血清PCT浓度之间的差异无显著性意义 (P >0 .0 5 ) ;随着感染的控制 ,PCT浓度逐渐下降至正常水平 ,若感染不能控制 ,PCT浓度将继续维持在可检测水平。结论 :PCT的检测可为肾移植术后并发细菌感染的诊断 ,及其和急性排斥反应的鉴别诊断提供有效的实验室依据。     

肾移植术后可溶性白细胞介素-2受体的动态监测及临床意义

目的 :观察肾移植术后急性排斥反应、感染、CsA中毒时血清可溶性白细胞介素 2受体 (sIL - 2R)变化 ,以探讨其在急性排斥反应的早期诊断、鉴别诊断中的意义。方法 :采用双抗体夹心酶联免疫吸附法 ,对 10 6例肾移植患者血清sIL - 2R活性水平于肾移植手术前后进行动态监测。结果 :肾移植术前sIL - 2R与对照组差别显著 ,术后 1周内下降明显 ,2周～ 3周后有所回升并趋于稳定。发生急性排斥反应前 1d～ 3d血清sIL - 2R即有升高 ,经MP、OKT3冲击有效后迅速下降。并发感染时sIL -2R显著升高 ,CsA中毒时sIL - 2R变化不明显。结论 :动态监测sIL - 2R可以作为急性排斥反应的早期诊断、鉴别诊断的免疫生物学指标。     

肾移植患者手术前后血清sIL-2R检测

目的：探讨血清可溶性白细胞介素2受体（sIL-2R）在肾移植急性排斥中的应用价值。方法：采用双抗体夹ELISA法检测170例肾移植患者手术前后血清sIL-2R浓度。肾移植患者分为肾病组（n=27），慢性肾炎组（n=137)，感染组（n=6），另设正常对照组（n=20)。结果：sIL-2R术后较术前明显升高者27例，分别为肾病组12例，慢性肾炎组9例，感染组6例，27例患者术后血清sIL-2R水平显著高于正常对照组（P＜0．01），经临床证实为急性排斥者21例，余6例因感染引起，结论：血清sIL-2R浓度可以作为肾移植排斥反应早期诊断一个有实有价值指标。     

同种异体肾移植患者B型钠尿肽水平的临床观察

目的：探讨同种异体肾移植患者和发生急性排斥反应时血浆B型钠尿肽（BNP）水平及其临床意义。方法：采用免疫夹心化学发光法检测17例首次肾移植患者术前1d、术后第1天、第2天、第3天、1周、2周和3个月血BNP浓度。17例健康体检者作对照。结果：肾移植患者术前1d血BNP浓度显著高于健康对照组（P〈0．01）。肾移植术后血BNP浓度呈下降趋势（χ^2=14．25，P=0．027）。13例没有发生急性排斥反应的患者血BNP浓度术后1周和3个月与肾移植术前比较差异有显著性（P〈0．05）；4例发生急性排斥反应患者，发生急性排斥反应当天的血BNP浓度显著增高，加强抗排斥治疗后很快下降。结论：肾移植成功后可以降低血BNP水平，但发生急性排斥反应时血BNP浓度显著增高。因此，血BNP浓度可作为早期诊断移植肾急性排斥反应发生的敏感指标。     

sCD30动态监测在移植肾急性排斥反应时的意义

[摘要] 目的 探讨血清可溶性CD30（sCD30）水平在肾移植术后急性排斥反应（AR）的变化及意义。方法 采用酶联免疫吸附法对肾移植术后22例发生AR的患者及20例顺利恢复,无排斥反应的患者sCD30水平进行动态监测,观察比较两组患者sCD30的变化规律。结果 排斥反应组术后具有较高的sCD30水平,和无排斥反应组相比在术后第5d、第7d有统计学意义(P<0.05)。排斥反应组sCD30水平在糖皮质激素冲击治疗后下降,但耐糖皮质激素性排斥者的下降速度较糖皮质激素敏感性排斥者缓慢,冲击治疗后的sCD30差异具有显著性(P<0.05)。结论 sCD30水平变化可作为肾移植AR的诊断指标及判断排斥反应对糖皮质激素冲击治疗是否敏感。     

血清Ⅳ型胶原测定在肾移植中的意义

目的：探讨血清Ⅳ型胶原（Ⅳ－Ｃ）动态变化在肾移植术后监测中的意义。方法：检测６１例肾移植患者血清Ⅳ－Ｃ浓度,观察不同病情状况时血清Ⅳ－Ｃ浓度的改变。结果显示：肾移植术前及术后动态测定血清Ⅳ－Ｃ浓度有助于早期诊断和鉴别诊断急性排斥反应（ＡＲ）、急性肾小管坏死（ＡＴＮ）和感染,可作为肾移植监测的一个辅助指标。     

急性白血病肺部浸润患者血清sIL—2R表达及临床意义

目的：探讨可溶性白细胞介素Ⅱ受体在急性白血病肺部浸润患者中的表达及临床意义。方法：用酶联免疫吸附法测定92例急性白血病患者血清可溶性白细胞介素Ⅱ受体水平,将患者是否并发肺部浸润,感染进行分组,并动态观察32例肺部浸润患者化疗前后可溶性白细胞介素Ⅱ受体水平。结果：急性白血病患者血清可溶性白细胞介素Ⅱ受体含量高于正常人,肺部润者明显高于无浸润者,可溶性白细胞介素Ⅱ受体水平与急性白血病肺部感染无关。结论：可溶性白细胞介素Ⅱ受体水平随着急性白血病肺部浸润患者免疫功能下降明显升高,可以作为早期诊断的一个筛选指标。     

2剂赛尼哌预防肾移植术后急性排斥反应的应用研究

目的 :探讨赛尼哌在预防同种肾异体移植术后急性排斥反应的作用。方法 :回顾分析了已随访 1年的 32例应用 2剂赛尼哌患者的临床效果 ,并以同期肾移植 92例作为对照组。结果 :赛尼哌组在 3月内急性排斥反应发生率 (3.1% )显著低于对照组 (2 3.9% ) (P <0 .0 5 ) ,在感染及副作用方面与对照组无显著性差异。结论 :2剂赛尼哌加上CsA ,MMP ,Pred联合应用的免疫抑制方案对预防同种尸体肾移植受者的急性排斥反应的发生是安全有效的。     

Clinical application of real time-polymerase chain reaction in determining cytomegalovirus viral DNA load in renal transplant recipients

Background Cytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients.Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients.This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.Methods Plasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers.The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.Results CMV-DNA was detected in 29 of 77 recipients,yielding a positive rate of detection of 37.7％ for this procedure.Twelve of the 21 recipients (57.1％) who suffered acute rejection had positive CMV-DNA.Among the 56 recipients suffered from chronic or mild rejection,17 (30.4％) had positive CMV-DNA plasma.Moreover,of the 29 recipients who had detectable CMV-DNA after transplant,12 (41.4％) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA,only nine (18.8％) developed acute rejection.Post-transplant patients with acute rejection had a higher rate (57.1％ vs.30.4％,P=0.03) of post-transplant CMV infection than those with chronic or mild rejection.Conclusion CMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.Chin Med J 2012; 125(19):3575-3577     

sIL-2R和16在肝移植术后早期急性排斥和细菌感染中的诊断价值

目的探讨血浆和胆汁中可溶性白细胞介素2受体(sIL-2R)和白细胞介素6(IL-6)对于肝移植术后早期急性排斥和细菌感染的诊断价值.方法对20例肝移植患者进行研究,测定围手术期血浆及胆汁中的sIL-2R和IL-6.结果急性排斥时,血浆sIL-2R在病理诊断前就可升高,胆汁IL-6在4例患者中3例日升幅大于450 pg/ml;细菌感染时,血浆IL-6可明显升高;胆汁sIL-2R在急性排斥和细菌感染时均无明显变化.结论sIL-2R和IL-6对于肝移植术后早期急性排斥和细菌感染的诊断有一定的价值.     

舒莱预防肾脏移植物急性排斥反应的随机对照试验研究

目的：探讨白细胞介素2受体单克隆抗体——舒莱（Simulect）对移植肾急性排斥反应的预防作用以及用药的安全性与药物的毒副作用。方法：将我器官移植移植中心1999年3月～2002年10月共46例肾移植受者为研究对象，随机分成舒莱组（23例）和对照组（23例），两组肾移植术后均接受以Neoral为基础的三联免疫抑制剂。舒莱组术前2h和术后4d各给予舒莱20mg静脉滴注。观察急性排斥反应、Neoral、皮质激素和硫唑嘌呤用量及药物的毒副作用。实验室检测血CsA浓度和肝肾功能。结果：研究结果表明，舒莱组无1例发生急性排斥反应，对照组术后8周内发生3例4次急性排斥反应。两组均未发生明显的毒副作用。两组间Neoral用量及血CsA浓度无明显差异。对照组因发生急性排斥反应，8周内皮质激素用药量总量大于舒莱组。结论：舒莱对移植肾急性排斥反应具有明显的预防作用，且用药方法简便，疗程短，无明显的毒副作用。     

肾移植受者BK病毒感染的临床诊断及治疗

目的 探讨肾移植受者BK病毒(BKV)感染的诊断及治疗方法.方法 选取肾移植术后48个月内的患者共227例.采集其血、尿样本,行BKV尿沉渣细胞学计数与实时荧光定量PCR检测病毒拷贝.对部分肾移植受者进行移植肾活检.将尿或血中BKV DNA阳性患者80例分成干预组(51例)与对照组(29例).干预组进行调整免疫抑制剂:19例环孢素A(CsA)减量,22例他克莫司(FK506)减量,10例FK506转换成CsA;对照组不进行干预,并且密切监测急性排斥反应.干预3个月后再次检测,比较组内和组间干预前后BKV活化指标的差异.结果 227例受者的尿decoy细胞、BK病毒尿症与病毒血症的阳性率分别为33.O%、33.5%和15.4%.干预组干预后尿decoy细胞、尿和血BKV数量的中位水平均为O,明显低于干预前(5.0个/10HP,1.50 x 104拷贝/ml,0拷贝/ml,均P<0.01).对照组观察前后尿decoy细胞、血BKV数量的中位水平差异无统计学意义(6.0个/10HPvs 5.0个/10HP、0拷贝/ml vs 0拷贝/ml,均P>0.05),尿BKV数量观察结束时上升(观察前:0.79×104拷贝/ml,观察后:2.21 x104拷贝/ml,P<0.01).上述各项指标干预前后的差值在干预组与对照组间差异均有统计学意义(均P<0.05).干预过程中所有患者均未出现急性排斥反应.确诊BKV相关性肾病4例,其干预治疗后尿decoy细胞计数以及血、尿BKV DNA均明显降低,移植肾功能有所恢复.结论 定量尿沉渣细胞学检测简单、易行、敏感,可以作为BKV活化的指标,间接反映肾脏病理情况.也可检测血、尿BKV DNA了解病毒活化情况、筛查BKV相关的移植肾肾病.减少免疫抑制剂剂量或换FKS06为CsA治疗肾移植术后BKV感染效果良好.     

Use of PCR and PCR-SSP for detection of urinary donor-origin DNA in renal transplant recipients with acute rejection

Objective To analyze the urine of renal recipients for the pressence of donor DNA in an attempt to establish an alternative diagnostic means of acute rejection.Methods Sixty-four renal transplant recipients were examined.Thirty-seven were normal after transplantation,while 22 others developed acute rejection,based on serum creatinine levels and/or needle biopsy findings of the graft.Five developed drug-induced renal dysfunction.In female recipients with a male graft,we examined urine for the presence of Ychromosome(SRY and DYZ-1) and in recipients receiving and HLA mismatched graft,we looked for HLA-DR gene(DRB1)using PCR.Results Among the 14 female recipients with male grafte demonstrating stable renal function,only one was positive for SRY and DYZ-1 on the Y chromosome.However,sry AND DYZ-1 were found in the urine of four female patients with acute rejection,but these DNA fragments were not detected in 3 of the 4 after anti-rejection therapy.The last patient was referred to hemodialysis.Of 23 recipients of a graft from HLA mismatch donors with stable renal function,DRB1 was negative in 21(91%).Of 18 patients with acute rejection,DRB1 was positive in 16(89%)and negative in 2.these ENA fragments were no longer found in 13 patients after anti-rejection therapy.In all patients with drug induced renal dysfunction,donor-derived DNA was negative.Conclusions Presence of door specific DNA in the urine of the recipient is strongly associated with acute rejection.Analysis of dna DNA derived from donor cells in urine was an effective and accurate method for the diagnosis of acute rejection of a renal transplant.     

Daclizumab prevents acute renal allograft rejection. 1 year analysis

Objective To investigate the clinical effect of Daclizumab on preventing acute rejection in renal transplant recipients.Methods71 patients were randomly divided into two groupsDaclizumab group (n =26) and control group (n = 45). Baseline regimen of mycophenolate mofetil (MMF), cyclosporin (CsA), methylprednisolone (MPD) and prednisone (Pred) were administered to all patients. The treatment of Daclizumab was based on baseline regimen. The Daclizumab group received Daclizumab twice before and after renal transplant. The occurrence of post-transplantation acute rejection, renal function and T lymphocyte subtypes were sequentially monitored; meanwhile adverse events, infection episode, and patient and graft survival were observed.All of patients received a follow-up of 12 months at least. Results The occurrence of acute rejection in Daclizumab group in 1,3, 6 and 12 months after renal transplantation was 7.7%, 19.2%, 23.1% and 30.8%, respectively,while it was 15.6% ,28.9%,35.6% and 46.7% in the control group. There was significant difference between the two group(P ＜ 0.05). There was no difference in infection episodes and adverse events between the Daclizumab group and control group. One year patient survival was 92.3% in Daclizumab group, 91.1% in control group (P ＞ 0.05), compared with graft survival of 96.2 % and 93.3 % for Daclizumab and control group, respectively (P ＞ 0. 05). The renal function in Daclizumab group in 1, 6 and 12 months after renal transplantation was better than that in control group (P ＜ 0.05). The CD3 and CD4 subtypes decreased in both two groups after operation but no significant difference (P ＞ 0.05). ConclusionDaclizumab combined with MMF, CsA, MPD and Pred therapeutic regimen was effective to reduce the occurrence of acute rejection in renal transplant recipients and have no influence on T lymphocyte subtypes.     

移植肾急性排斥反应中外周血CD40、CD40L分子的表达及临床意义

目的 研究移植肾出现急性排斥反应时,受者外周血中白细胞CD40、CD40L分子的表达及临床意义.方法 将患者分成2组,急性排斥反应组15例,未出现排斥反应组(对照组)41例,采用流式细胞仪检测56例肾移植受者外周血CD40、CD40L在CD4 、CD8 T细胞表面的表达.结果 当发生急性排斥反应时,受者的外周血CD40、 L分子的表达均增强,排斥组与未排斥组间差异有显著性.结论 肾移植急性排斥反应的发生与CD40、CD40L共刺激通路的活化有十分密切关系,CD40、CD40L分子的表达随急性排斥反应的增加而显著上升.可作为临床上对急性排斥反应的无创性诊断方法之一.     

Parainfluenza type 3 in a transplant unit.

We observed an epidemic of parainfluenza type 3 viral infection in a renal transplantation service among 16 recent transplant recipients. To assess the effect of infection on transplant function, we retrospectively compared the infected patients with a matched, uninfected control group. In addition to symptoms of a mild upper respiratory tract infection associated with the epidemic, there was an increase in the frequency of acute rejection episodes during the period of infection in the infected group. Nevertheless, outcome in terms of patient and graft survival at six months was not affected when compared with the survival rates of the control group.