ImmuKnow检测免疫细胞功能在肾移植术后免疫功能监测中的应用

目的  探讨ImmuKnow检测免疫细胞功能在监测肾移植术后患者免疫功能变化的应用价值。方法  2013年1月至2014年12月在广州医科大学附属第二医院器官移植科实施肾移植手术的106例尿毒症患者, 分别于术前、术后12个月内发生感染或急性排斥反应时抽取血液标本。采用ImmuKnow测定CD4⁺ T细胞内的三磷腺苷(ATP)含量。观察与比较不同临床状态肾移植患者的ATP含量, 包括术前组、稳定组、急性排斥反应组和感染组(含重症肺炎)。检测外周血T细胞亚群CD4⁺T细胞、CD8⁺T细胞及自然杀伤(NK)细胞比例。采用Pearson相关分析法了解ATP值与他克莫司(FK506)和环孢素(CsA)血药谷浓度的关系。结果  感染组患者ATP含量低于术后稳定组患者(P < 0.001), 其中发生重症肺炎患者ATP含量低于发生其他感染的患者(P < 0.05)。感染组患者的CD4⁺T细胞百分比低于稳定组患者(P < 0.05)。ATP含量与移植患者术后FK506和CsA血药谷浓度无相关性。结论  ImmuKnow检测可用于监测肾移植患者术后免疫功能状态。CD4⁺T细胞内ATP含量检测对术后感染, 特别是对重症肺炎有提示和预警作用。

Application of ImmuKnow immune cell function assay in monitoring of immune function after renal transplantation

Objective To investigate the application value of ImmuKnow immune cell function assay in monitoring of immune function changes after renal transplantation. Methods One hundred and six patients with uraemia undergoing renal transplantation in the Department of Organ Transplantation of the Second Affiliated Hospital of Guangzhou Medical University from January 2013 to December 2014 were included. Blood specimens were collected before transplantation and at the occurrence of infection or acute rejection during 12 months after transplantation. ImmoKnow was used to determine the adenosine triphosphate(ATP) content in CD4+T cells. The ATP content of patients with renal transplantation at different clinical conditions were observed and compared, including periopreative group, stable group, acute rejection group and infecticn group(including severe pneumonia). The ratio of T cell subsets (CD4+T cells, CD8+T cells) and natural killer (NK) cells in peripheral blood were detected. Pearson correlation analysis was used to detect the association between ATP and the blood trough concentration of tacrolimus (FK506) and ciclosporin (CsA). Results The ATP content of the patients in the infection group was lower than that of the patients in the stable group (P < 0.001). The ATP content of patients with severe pneumonia was lower than that of patients with other infections (P < 0.05). The percentage of CD4+T cells of the patients in the infection group was lower than that of the patients in the postoperative stable group (P < 0.05). The ATP content was not associated with the postoperative blood trough concentration of FK506 and CsA. Conclusions ImmuKnow assay may be used to monitor the postoperative immune function of patients after renal transplantation. The detection of ATP content in CD4+T cells has hinting and pre-warning function for postoperative infection, especially for severe pneumonia.