胆汁可溶型抑制性受体LAIR-1以及白介素-2受体监测在肝移植急性排斥反应中的意义

目的 探讨胆汁中sLAIR-1及IL-2R的表达在肝移植排斥反应中的意义.方法 连续3周应用双单克隆抗体夹心ELISA方法检测55例肝移植受者术后胆汁sLAIR-1及sIL2R水平.结果 在22例移植肝功能正常的受体中(对照组),胆汁sIL-2R在(23.1±3.5)～(55.1±6.1)ng/L范围之内呈较低水平的波动,sLAIR-1则波动于(3.2±1.1)～(6.1±1.4)ng/L范围之内,亦呈低水平表达.在急性排斥反应(AR)组,胆汁sIL-2R水平在排斥反应确诊前2 d为(116.1±10.3)ng/L,确诊前1 d则为(136.8±12.7)ng/L,均显著高于对照组(P＜0.01).在经激素冲击治疗3 d时则下降至(74.2±6.2)ng/L,明显低于确诊前1、2 d水平.在对照组,胆汁sLAIR-1在(3.2±1.1)～(6.1±1.4)ng/L范围之内呈较低水平的波动;在AR组确诊前3 d为(18.1±2.2)ng/L,确诊前2 d为(25.1±3.5)ng/L,确诊前1 d则为(31.1±5.5)ng/L,均显著高于对照组(P＜0.01);经激素冲击治疗3 d时,胆汁sLAIR-1水平下降至(8.1±2.5)ng/L,接近对照组水平,且sLAIR-1的下降早于sIL2R.结论 胆汁sLAIR-1在发生移植肝急性排斥反应的病人血清中有较高水平的表达,其波动较sIL-2R大,将二者联合进行监测,可望成为早期预测移植物排斥反应发生及转归的诊断指标.

Role of monitoring of bile soluble inhibitory receptor LAIR-1 and interleukin-2 receptor expression in liver acute rejection

Objective Based on detection of the soluble LAIR-1 (sLAIR-1) and sIL-2R in the bile from recipient after liver transplant, the role of sLAIR-1 and sIL-2R in graft acute rejection were analyzed. Methods Bile sLAIR-1 level and sIL-2R were determined by double mAb sandwich enzyme linked immunosorbent assay in 55 cases of liver transplantation. Results In 22 recipients with normal graft function, sLAIR-1 and sIL-2R were detected at low level in the bile. In the 29 cases of liver acute rejection (AR), significant increase of bile sIL-2R level was detected on the lst and 2nd d before final diagnosis. With the effective methylprednisolone pulse therapy, sIL-2R level was decreased significantly on the 3rd d. On the other hand, remarkable increase of bile sLAIR-1 was found on the lst,2nd and 3rd d before final diagnosis. After of methylprednisolone pulse therapy for 3 d, bile sLAIR-1resturned to the control level. Conclusion Both bile sIL-2R and sLAIR-1 are detected at high level in the recipients suffering from liver acute rejection. The level of bile sLAIR-1 changes dramatically and responsively according to liver acute rejection. Therefore, detecting these two markers synergistically may be a promising monitor for rejection after liver transplantation.