肾移植术后泌尿系恶性肿瘤患者T淋巴细胞亚群的测定及意义

  目的  观察肾移植术后并发泌尿系统恶性肿瘤患者血液T淋巴细胞亚群的变化, 及其对调整免疫抑制剂及预防恶性肿瘤的意义。  方法  9例肾移植术后并发泌尿系统恶性肿瘤患者为肿瘤组, 9例未发生任何肿瘤或感染的肾移植患者为移植组, 9例健康体检者为对照组。流式细胞术测定T淋巴细胞亚群(CD3+T、CD3+CD8+T、CD3+CD4+T、CD4+/CD8+)比例, 肿瘤组行肿瘤切除并减少免疫抑制剂用量, 测定术前及术后2个月血药CsA和FK506浓度。  结果  肿瘤组与另两组比较, CD3+T及CD3+CD8+T无明显变化, CD3+CD4+T明显减少, CD4+/CD8+比值明显降低(P < 0.05)。肿瘤组肿瘤切除术后2个月与术前比较, CD3+T和CD3+CD4+T无明显变化; CD3+CD8+T明显降低, 而CD4+/CD8+比值明显升高(P < 0.05), CsA和FK506血药浓度均明显降低(P < 0.05)。  结论  血T淋巴细胞亚群可作为肾移植免疫状态的有效评价指标, 对指导肾移植免疫抑制剂的调整和预防肿瘤的发生具有重要的临床意义。 

T-lymphocyte Subset Analysis in Renal Transplant Recipients with Malignant Tumors in the Urinary System

  Objectives  To investigate T-lymphocyte subset changes in renal transplant recipients with malignant tumors of the urinary system, and evaluate the clinical significance of T-lymphocyte subset analysis for regulating immunosuppressive agents and preventing malignant tumors.  Methods  Nine renal transplant recipients with malignant tumors in the urinary system were assigned as the tumor group. Nine renal transplant recipients with normal renal function and no tumor or infection were assigned as the transplant group. Nine healthy adults were assigned as the control group. The T-lymphocyte subsets (CD3+T, CD3+CD8+T, CD3+CD4+T, and CD3+/CD8+) of all patients were measured by flow cytometry. The dosage of immunosuppresive agents in the tumor group decreased after surgical resection of the malignant tumor. The drug concentration of CsA and FK506 were detected before and two months after surgery.  Results  The CD3+ and CD3+ CD8+ T-lymphoeytes in the tumor group were similar to those in the other two groups. The CD3+CD4+ T-lymphocytes and CD4+/CD8+ ratio were significantly lower in the tumor group than in the other two groups (P < 0.05). There was no significant change in CD3+ and CD3+CD4+ T-lymphocytes in the tumor group before and two months after surgery. However, the CD3+CD8+ T-lymphocytes in the tumor group were significantly lower before surgery than two months after. In contrast, the CD4+/CD8+ ratio in the tumor group were significantly higher before surgery than two months after (P < 0.05). The drug concentrations of CsA and FK506 in the tumor group were significantly lower two months after surgery than before (P < 0.05).  Conclusion  T-lymphocyte subset analysis can be used as an effective marker for evaluating the immune status after renal transplantation. This analysis has important clinical significance in regulating immunosuppressive agents as well as preventing over-immunosuppression and tumor occurrence.