流式细胞技术检测肾移植后外周血白细胞介素18受体的表达

背景：细胞因子常常在肾移植后排斥反应早期即被释放，因此可以作为排斥反应的早期诊断指标。目的：观察尿毒症患者肾移植前后外周血白细胞介素18受体(IL-18R)表达的变化。方法：将2004-09/2005-09在解放军济南军区总医院进行的肾移植尿毒症32例患者分为肾功能稳定组24例，急性排斥组8例。另选择以往手术后移植肾功能正常，平均存活时间4年的肾移植患者12例为长期存活组。同期查体未发现异常健康自愿者7例为健康对照组。提取受试者的外周血淋巴细胞，加入双荧光标记的鼠抗人CD4/IL-18Rα及CD8/IL-18Rα单克隆抗体，利用流式细胞仪进行测定。结果与结论：流式细胞技术检测CD4/IL-18Rα及CD8/IL-18Rα在尿毒症组的阳性率明显高于健康对照组(P=0.02，P=0.04)。肾功能稳定组及长期存活组外周血CD4/IL-18Rα及CD8/IL-18Rα的表达明显低于急性排斥组(P < 0.05)。急性排斥反应组激素冲击治疗后其阳性率明显低于激素冲击治疗前(P < 0.05)。3例耐激素排斥反应者IL-18R表达值高于5例激素治疗有效者。结果显示外周血CD4/IL-18Rα及CD8/IL-18Rα的变化可以较早预测肾移植后急性排斥反应，预测肾移植后恢复情况，评估排斥反应对激素治疗的效果。

Clinical implication of monitoring interleukin-18 receptor in peripheral lymphocytes using flow cytometric after renal transplantation

BACKGROUND:As cytokines are often released in the early stage following renal transplantation, they can used as an indicator for early diagnosis of rejection.OBJECTIVE:To investigate the expression of interleukin 18 receptor (IL-18R) in peripheral blood of uremia patients before and after renal transplantation.METHODS:The expression of CD4/IL-18Rα and CD8/IL-18Rα in peripheral lymphocytes was determined using flow cytometric analysis in 32 uremia patients receiving renal transplantation including 24 patients with stable function, 8 with acute rejection, 12 who had a long-term survival (average 4 years), and 7 healthy controls.RESULTS AND CONCLUSION:CD4/IL-18Rα and CD8/IL-18Rα positive rates were higher in the uremia patients than the healthy controls (P=0.02, P=0.04). The expression of CD4/IL-18Rα and CD8/IL-18Rα in peripheral lymphocytes in the patients with stable function and those who had a long-term survival was lower than that in the patients with acute rejection. After steroid plus therapy, the positive rates for CD4/IL-18Rα and CD8/IL-18Rα were decreased significantly in the patients with acute rejection (P < 0.05). IL-18Rα expression was stronger after steroid pulse therapy in the 3 patients resistant to steroids than in the 5 patients responsive to steroid treatment. The results demonstrate that detection of CD4/IL-18Rα and CD8/IL-18Rα in the peripheral lymphocytes by flow cytometric analysis was an easy, hopeful, and noninvasive means for the diagnosis and treatment of patients with acute rejection after renal transplantation.