肾移植受者血清sFas和sFasL变化及在早期急性排异反应预测中的应用

背景：细胞凋亡在移植免疫和移植物功能丧失发生过程中起十分重要的作用,其中Fas/FasL系统被认为是细胞凋亡参与肾移植的急性排异反应过程的主要途径之一。目的：分析肾移植受者术后血清sFas和sFasL水平变化及其在预测早期急性排异反应中的应用价值。方法：肾移植受者80例分为肾功能稳定组(49例)、急性排斥反应组(23例)和环孢素A中毒组(8例)。另选择性别、年龄与肾移植受者相匹配的健康体检者50例为对照组。肾移植受者术后均常规使用环孢素A+硫唑嘌呤+泼尼松三联免疫抑制治疗。发生急性排斥反应时给予每日甲基强的松龙6~8 mg/kg冲击治疗,3 d为1个疗程。采用ELISA法检测患者手术前后的血清sFas和sFasL水平。结果与结论：肾移植组患者手术前的血清sFas和sFasL水平均明显高于对照组(P  < 0.05)。急性排斥反应组血清sFas、sFasL水平高于相同时间段肾功能稳定组(P < 0.05)。环孢素A中毒的肾移植患者术后各时间点血清sFas、sFasL水平变化与肾功能稳定组基本相同,差异无显著性意义。提示动态监测血清sFas、sFasL水平可能对早期诊断及鉴别诊断肾移植急性排斥反应具有重要参考价值。

Changes in serum soluble Fas and soluble Fas ligand of renal graft recipients in early period post-transplant as a predictor of acute renal allograft rejection

BACKGROUND:Apoptosis of target cells plays a crucial effect on acute rejection after organ transplantation. Fas/Fas ligand (FasL) system is considered as one of action pathways of acute rejection after organ transplantation.OBJECTIVE:To study the serum soluble Fas and soluble FasL levels of renal graft recipients in early post-transplant period and their application as a predictor of acute renal allograft rejection. METHODS:The sequential monitoring of serum soluble Fas and soluble FasL levels in 80 patients was conducted by ELISA technique before and after renal transplantation and the relationship between sFas/sFasL with acute renal allograft rejection were analyzed.RESULTS AND CONCLUSION:The levels of serum soluble Fas and soluble FasL in the patients for renal transplantation were significantly higher than that in control before operation (P < 0.05). The levels of serum soluble Fas and soluble FasL in acute rejection group at same time were significantly higher than that in normal group after operation (P < 0.05), and compared with that in CsA-induced nephrotoxicity group, there was no significant difference. The sequential monitoring of serum soluble Fas and soluble FasL in renal allograft recipients may be of a useful value to make early and differential diagnosis of acute renal rejection．