血清可溶性细胞间粘附分子-1在肾移植监测中的价值

采用双抗体夹心酶联免疫法对８７例肾移植患者进行细胞间粘附分子１（ｃＩＣＡＭ１）动态监测，以探讨其在术后监测中的价值。结果发现，移植术后ｃＩＣＡＭ１水平短暂升高后即随移植肾功好转而下降，至术后两周达正常水平；急性排斥反应时ｃＩＣＡＭ１显著高于移植肾功稳定组及ＣｓＡ肾中毒组（Ｐ＜０．００１）；抗排斥治疗有效后，ｃＩＣＡＭ１又逐渐降至正常水平。结果表明，肾移植术后动态监测ｃＩＣＡＭ１的变化，不仅可早期诊断急性排斥反应并观察其治疗效果，而且有助于急性排斥反应与ＣｓＡ肾中毒的鉴别。     

血清可溶性血管细胞粘附分子—1测定在肾移植急性排斥反应 …

目的：探讨血清可溶性血管细胞粘附分子－１（ｓＶＣＡＭ－１）测定在肾移植术后免疫学监测中的价值。方法：采用酶联免疫吸附法（ＥＬＩＳＡ）动态监测５６例肾移植患者术后ｓＶＣＡＭ－１水平的变化。结果：肾移植患者术后ｓＶＣＡＭ－１水平呈规律性变化,急性排斥反应组ｓＶＣＡＭ－１水平明显高于移植肾功能稳定组和ＣｓＡ肾中毒组,差异有非常显著意义（Ｐ〈０．０１）。对激素治疗敏感的排斥反应患者,ｓＶＣＡＭ－１逐渐降至     

细胞间粘附分子-1(ICAM-1)与肾脏移植排斥反应

ＩＣＡＭ－１是介导肾移植急性排斥反应的重要细胞粘附分子。肾移植急性排斥反应时肾脏组织ＩＣＡＭ－１表达增加，血、尿中可溶性的ＩＣＡＭ－１（ｓＩＣＡＭ－１）升高。动态监测肾移植术后患者血、尿中ｓＩＣＡＭ－１的变化，有助于肾移植急性排斥反应的诊断和抗排斥反应的疗效评价，应用ＩＣＡＭ－１单克隆抗体，可以提高肾移植成功率。     

肾移植后尿中可溶性细胞间粘附分子-1浓度监测的临床意义

目的：评价肾移植后患者尿中可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）浓度变化的临床意义。方法：动态检测２０例肾移植患者术后２个月内尿中ｓＩＣＡＭ－１浓度的变化。结果：急性排斥反应（ＡＲ）时,ｓＩＣＡＭ－１的升高较临床诊断提早数天,并且显著高于环孢素Ａ肾中毒组;对甲基氢化泼尼松敏感的排斥反应,抗排斥治疗数天后ｓＩＣＡＭ－１下降到排斥前水平。结论：肾移植术后动态监测受者尿中ｓＩＣＡＭ－１浓度有助于ＡＲ     

细胞间粘附分子-1和血管细胞粘附分子-1在慢性排斥反应中的表达

为了探讨移植肾慢性排斥反应的发病机制，应用免疫组化技术（ＡＢＣ法）对１６例肾移植术后发生慢性排斥反应患者的移植肾组织及５例正常肾组织行细胞间粘附分子－１（ＩＣＡＭ－１）、血管细胞粘附分子－１（ＶＣＡＭ－１）染色及ＨＥ染色。结果表明ＩＣＡＭ－１、ＶＣＡＭ－１在正常肾脏和慢性排斥反应移植肾脏上的表达分布不同；结果提示，它们在移植肾慢性排斥反应的发生、发展过程中起重要作用     

可溶性细胞间粘附分子—1和肿瘤坏死因子在监测肾移植排斥反应 …

目的 探讨血清可溶性细胞间粘附分子－１（ｓＩＣＡＭ－１）和肿瘤坏死因子（ＴＮＦ）在肾移植排斥反应监测中的意义。方法 采用双抗体夹心法和Ｌ９２９靶细胞法对４１例肾移植患者术后血清中ｓＩＣＡＭ－１和ＴＮＦ进行动态监测。结果 肾移植术后血清ｓＩＣＡＭ－１和ＴＮＦ出现相似的变化；术后肾功能稳定恢复组，环孢素Ａ（ＣｓＡ）肾中毒组与尿毒症组及正常对照组间血清ｓＩＣＡＭ－１和ＴＮＦ水平无显著性差异；当发生急性排     

细胞间粘附分子—1（ICAM—1）与肾脏移植排斥反应

ＩＣＡＭ－１是介导肾移植急性排斥反应的重要细胞粘附分子。肾移植急性排斥反应时肾脏组织ＩＣＡＭ－１表达增加，血，尿中可溶性的ＩＣＡＭ－１同。动态监测肾移植术后患才血，尿中ｓＩＣＡＭ－１的变化，有助于肾移植急性排斥的诊断和抗排斥反应的疗效评价，应用ＩＣＡＭＰ－１单克隆抗体，可以提高肾移植成功率。     

HCV感染对肾移植患者T细胞亚群及HLA-DR表达的影响

目的　了解ＨＣＶ 感染对肾移植患者免疫功能及感染和急性排斥反应的影响。　方法　采用直接免疫荧光标记法测定患者外周血Ｔ 细胞亚群及ＨＬＡＤＲ 的表达,并统计ＨＣＶ 感染组和对照组感染和急性排斥反应的发生率。　结果　ＨＣＶ 感染组ＣＤ４ 、ＣＤ２８ 、ＣＤ４／ＣＤ８ 值明显低于无感染组（ 分别为４１ ．３±５ ．１、５５．２ ±５ ．８ 、１．４９±０．４ 和４９ ．１ ±８ ．２ 、６４．８±５．０、１．８１ ±０．５）,ＨＣＶ 感染组Ｔ 细胞ＨＬＡＤＲ 的表达比对照组明显下降（６ ．９ ±４．２ ｖｓ １１．９ ±４．８）,感染和急性排斥反应的发生率两组差异无显著性（分别为２５．０％ 、１０ ．０％ 和１７ ．５％ 、１２．５ ％ ）。　结论　ＨＣＶ 感染可抑制肾移植患者的细胞免疫功能,但不影响患者感染及急性排斥反应的发生率。     

胃肠道肿瘤患者血清可溶性细胞间粘附分子1和可溶性内皮细胞-白细胞粘附分子1含量的临床意义

目的探讨可溶性细胞间粘附分子１（ｓＩＣＡＭ１）和可溶性内皮细胞白细胞粘附分子１（ｓＥＬＡＭ１）含量与胃肠道肿瘤患者预后的关系。方法用双抗体夹心法测定６４例临床患者血清中ｓＩＣＡＭ１和ｓＥＬＡＭ１的含量。结果胃肠道良性病变患者血中ｓＩＣＡＭ１和ｓＥＬＡＭ１的含量均不升高（Ｐ＞０．０５）;而它们在胃肠道癌患者中的含量明显升高（Ｐ＜０．０１）;伴有肝转移的胃肠道肿瘤患者血中ｓＩＣＡＭ１的含量比无肝转移的癌患者有非常显著的升高（Ｐ＜０．０１）,而ｓＥＬＡＭ１的含量相差无显著性（Ｐ＞０．０５）。结论ｓＩＣＡＭ１的含量与胃肠道癌预后有关。     

肾移植患者术后早期应用霉酚酸酯的临床观察

目的 观察肾移植术后早期不同剂量霉酚酸酯（ＭＭＦ）与环孢素Ａ（ＣｓＡ）和泼尼松（Ｐｒｅｄ）联用预防急性排斥反应的效果及安全性。方法 将６４例肾移植患者分为３组,分别给予ＭＭＦ２．０ｇ／ｄ（Ａ组）、１．５ｇ／ｄ（Ｂ组）及Ａｚａ ５０～１００ｍｇ／ｄ（Ｃ组）,每组均联用ＣｓＡ及Ｐｒｅｄ（剂量相同）。观察肾移植术后６个月内急性排斥反应的发生率、移植肾功能及药物的副作用。结果 Ａ、Ｂ、Ｃ组急性排斥反应的发     

肾移植后测定血清可溶性细胞间粘附分子-1的临床意义

目的　探讨血清可溶性细胞间粘附分子 1(sICAM 1)在肾移植术后免疫学监测中的价值。方法　采用酶联免疫吸附法 (ELISA)动态监测 5 6例肾移植患者术后血清sICAM 1的变化。结果　肾移植患者术后发生排斥反应时 ,其sICAM 1水平 (390 .6 μg/L±91.0 μg/L)明显高于移植肾功能稳定者 (137.3μg/L±16 .8μg/L)和环孢素A(CsA)肾中毒者 (132 .7μg/L±2 4.8μg/L) ,差异有极显著性 (P <0 .0 1) ;抗排斥反应治疗有效后 ,sICAM 1逐渐降至正常水平 ;CsA肾中毒者的sICAM 1水平无明显变化。结论　肾移植术后动态监测患者血清sICAM 1水平的变化 ,有助于急性排斥反应的诊断、鉴别诊断及抗排斥治疗的疗效评价 ,可以作为肾移植术后急性排斥反应的免疫学监测指标。     

肾移植术后肝细胞生长因子的动态监测及临床意义

目的:探讨肝细胞生长因子(HGF)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50例肾移植受者血清HGF水平在手术前后进行动态监测。观察肾移植术后发生急性排斥反应(AR)、急性肾小管坏死(ATN)、环孢素(CsA)中毒时血清HGF的变化。结果:术前组HGF水平与对照组相比有统计学意义(P<0.05)。稳定组术后前3天HGF下降明显,2周左右降至对照组水平。AR组在典型症状出现及血Cr升高前1~3d,HGF即有升高,且峰值出现在抗排斥治疗的当天。经甲基泼尼松龙冲击后AR逆转者HGF迅速下降。ATN组HGF升高,与AR组相比有统计学意义(P<0.05)。CsA中毒组HGF水平升高,与AR相比有统计学意义(P<0.05),但与ATN组相比无统计学意义(P>0.05)。结论:动态监测HGF可能作为急性排斥反应的早期诊断敏感指标,并且对ATN、CsA中毒的鉴别诊断也具有一定临床应用价值。     

肾移植后血清白细胞介素2、可溶性白细胞介素2受体和白细胞介素6的监测

动态监测６０例肾移植患者术后２个月内血清白细胞介素２（ＩＬ－２）、可溶性ＩＬ－２受体（ｓＩＬ－２Ｒ）和白细胞介素６（ＩＬ－６）的变化。结果发现发生急性排斥反应时，上述细胞因子的升高较临床诊断提早数天，并且显著高于环孢素Ａ肾中毒组；对甲泼尼龙敏感的排斥反应，抗排斥治疗数天后上述因子下降到排斥前水平。提示肾移植术后动态监测患者血清ＩＬ－２、ｓＩＬ－２Ｒ和ＩＬ－６有助于急性排斥反应的早期诊断、鉴别诊断、及时治疗和甲泼尼龙抗排斥的疗效评价。     

Higher serum levels of soluble intracellular cell adhesion molecule‐1 and soluble vascular cell adhesion molecule predict peripheral artery disease in haemodialysis patients

Aim: Serum levels of soluble intracellular cell adhesion molecule‐1 (sICAM‐1), soluble vascular cell adhesion molecule‐1 (sVCAM) and monocyte chemotactic protein 1 (MCP‐1), are elevated in patients with peripheral artery disease (PAD). However, the levels of these cell adhesion molecules in patients undergoing haemodialysis (HD) are unclear. Method: A total of 112 HD patients were included and PAD was diagnosed using the ankle‐brachial index and Doppler ultrasound. Serum levels of sICAM‐1, sVCAM‐1 and MCP‐1 were assayed using enzyme linked immunosorbent assay. Results: Out of 106 HD patients, 31 (27.7%) were diagnosed with PAD. After adjusting for risk factors, higher serum levels of sVCAM‐1 and sICAM‐1 were associated with PAD in HD patients, with an odds ratio of 5.3 (95% CI 3.3–65.5) and 2.7 (95% CI 1.2–21.8) respectively. Using sVCAM‐1 and sICAM‐1 for diagnosis of PAD in HD patients, sVCAM‐1 had a sensitivity of 72.4% and specificity of 62.3% for sVCAM‐1 and sICAM‐1 had a sensitivity of 89.3% and a specificity of 40%. MCP‐1 was not associated with PAD in HD patients. In addition, the fistula of HD patients with PAD had a lower A‐V access flow. Conclusion: sVCAM‐1 and sICAM‐1 was associated with higher risk of PAD in HD patients. Moreover, HD patients with PAD had a lower blood flow and lower A‐V access flow. Our results showed that sVCAM‐1 and sICAM‐1 may be used as screening markers for PAD in HD patients.     

Is 3-hour cyclosporine blood level superior to trough level in early post-renal transplantation period?

PURPOSE: Cyclosporine dose is traditionally based on trough blood levels. Cyclosporine trough blood level correlates poorly with acute rejection and cyclosporine nephrotoxicity after renal transplantation. We determined whether cyclosporine blood level at any other time point is superior to cyclosporine trough blood level as a predictor of acute rejection and cyclosporine nephrotoxicity. MATERIALS AND METHODS: Cyclosporine blood level was measured before (trough), and 1, 2, 3 and 4 hours after the dose in 156 initial renal transplant cases 2 to 4 days after the initiation of cyclosporine micro-emulsion formula administration. The cylosporine micro-emulsion dose was based on cyclosporine trough blood level targeting 250 to 400 microg./l. RESULTS: Regression analysis revealed that only delayed graft function (p = 0.007) and cyclosporine blood level after 3 hours (p = 0.008) predicted acute rejection. Mean cyclosporine trough blood level plus or minus standard error was not significantly different in patients with and without acute rejection (293+/-21 versus 294+/-11 microg./l.). Mean cyclosporine blood level after 3 hours was significantly lower in patients with acute rejection (1,156+/-90 versus 1,421+/-50, p = 0.008). Cases were divided into tertiles at levels after 3 hours (1,100 and 1,500 microg./l.). The group in which the level after 3 hours was less than 1,100 microg./l. had the highest acute rejection rate (22 of 50 patients, 44%) and a cyclosporine nephrotoxicity rate of 13% (7 of 52 patients). The group in which the level after 3 hours was 1,100 to 1,500 microg./l. had the lowest acute rejection rate (5 of 46 patients, 11%) without increased cyclosporine nephrotoxicity (7 of 52 patients, 13%). A level after 3 hours of greater than 1,500 microg./l. was associated with a rejection rate of 15% (7 of 47 patients) but significantly higher cyclosporine nephrotoxicity (16 of 52 patients, 30%). CONCLUSIONS: Cyclosporine blood level after 3 hours in the early post-transplantation period is associated with acute rejection and cyclosporine nephrotoxicity. A cyclosporine blood level range after 3 hours of 1,100 to 1,500 microg./l. is associated with an optimal outcome. Our data suggest that cyclosporine blood level after 3 hours may represent a better method of monitoring cyclosporine micro-emulsion dose than cyclosporine trough blood level. This hypothesis must be further studied in randomized trials.     

The use of fine-needle intrarenal manometry in the management of renal transplant patients receiving cyclosporine

The pressure inside a renal transplant can be measured by means of a fine (25-G) needle passed into the kidney, and we have shown previously that a rise in pressure to more than 40 mmHg commonly occurs during rejection episodes. A rise was not observed in patients with cyclosporine nephrotoxicity or acute tubular necrosis, so we have now used this test prospectively as part of our management of 37 patients undergoing renal transplantation. Fine needle intrarenal pressure was recorded weekly during the first three weeks after transplantation, with more frequent measures taken in patients with deteriorating or absent renal function. Treatment was dictated by the result of these tests. Deteriorating function in a kidney registering a normal pressure was diagnosed as cyclosporine nephrotoxicity and the dose of cyclosporine was reduced appropriately. A pressure reading in excess of 40 mmHg was regarded as rejection--and, after obtaining a conventional needle biopsy of the kidney, antirejection treatment was commenced immediately. Nineteen episodes of nephrotoxicity were confirmed and there was only one false-positive result. Twenty-eight of twenty-nine rejection episodes (observed in twenty-three patients) were associated with a significant rise in intrarenal pressure and were treated appropriately. In six patients who were oliguric at the time, as a result of posttransplant acute tubular necrosis, this rise in pressure was the first indication of rejection. A high pressure was recorded on the first day that the creatinine rose in two-thirds of the cases. In the remainder the pressure was seen to rise more slowly, particularly when the rejection was of the chronic vascular type and was occurring two months or more after transplantation. Fine-needle intrarenal manometry accurately identified rejection episodes in newly transplanted patients--and, because the results were unaffected by cyclosporine nephrotoxicity and acute tubular necrosis, the test was of most value in monitoring patients with these conditions.     

Impact of rHuEPO therapy initiation on soluble adhesion molecule levels in haemodialysis patients

Background: Increased levels of soluble adhesion molecules have been reported in haemodialysis (HD) patients. Recent studies have shown that recombinant human erythropoietin (rHuEPO) elicits proliferation and migration of endothelial cells and modifies endothelial function. The present study was design to explore the effects of rHuEPO on serum levels of soluble adhesion molecules in HD patients. Methods: Soluble serum levels of E‐selectin (sE‐selectin), intracellular adhesion molecule‐1 (sICAM‐1) and vascular cell adhesion molecule‐1 (sVCAM‐1) were measured by ELISA in 29 rHuEPO naïve HD patients (20 males, 9 females) and 10 control subjects at baseline and second month. The HD patients with a haemoglobin level lower than 10.0 mg/dL (n = 19) were administered rHuEPO therapy and other HD patients (n = 10) were followed as a placebo group. Results: Serum levels of soluble adhesion molecules were significantly higher in HD patients compared with the control group. A significant rise from the baseline in sE‐selectin levels (77 ± 70 vs 100 ± 86 ng/mL, P < 0.05) was observed 2 months after rHuEPO initiation, while sICAM‐1 and sVCAM‐1 levels decreased (271 ± 261 vs 197 ± 89 and 1043 ± 243 vs 990 ± 236 ng/mL, respectively, P < 0.05). Conclusions: The present data indicate that rHuEPO could have an important action on serum levels of soluble adhesion molecules in HD patients. rHuEPO might modify the expression of adhesion molecules from endothelial cells either. However, the exact mechanism responsible for the serum elevation of these molecules in HD patients is yet to be fully elucidated.     

Soluble Adhesion Molecules During Ex Vivo Lung Perfusion Are Associated With Posttransplant Primary Graft Dysfunction

Ex vivo lung perfusion (EVLP) enables assessment of marginal donor lungs for transplantation. We aimed to discover biomarkers in EVLP perfusate that could predict development of primary graft dysfunction (PGD). From September 2008 to August 2013, 100 clinical EVLPs were performed. Eleven patients developed PGD grade 3 within 72 h after transplant. The non‐PGD group consisted of 34 patients without PGD grade 3. Nonbilateral lung transplants or transplant after extracorporeal life support were excluded from analyses. Soluble intercellular adhesion molecule 1 (sICAM‐1), soluble VCAM‐1 (sVCAM‐1), and soluble E selectin (sE‐selectin) levels, as markers of endothelial activation, were measured in the perfusate of EVLP by enzyme‐linked immunosorbent assay and were correlated with clinical outcome. Levels of sICAM‐1 at 1 h and sVCAM‐1 at 1 and 4 h were significantly higher in the PGD group compared with the non‐PGD group. The sE selectin levels were not statistically different between the study groups. Higher levels of sVCAM‐1 at 1 and 4 h were statistically significantly associated with PGD either alone or after adjustment for other PGD risk factors. These adhesion molecules may help identify donor lungs at higher risk of PGD during EVLP.