尿液DNA的检测在肾移植术后急性排斥反应诊断中的应用

目的　探讨肾移植受者尿液中供者细胞DNA的检测在诊断急性排斥反应的应用及其价值。方法　以供者为男性、受者为女性的35例肾移植受者为研究对象,定期收集尿液标本,从中提取DNA ,利用聚合酶链反应检测Y染色体上特异的基因片段DYZ -1。结果　手术第1日受者的尿液中即有供者细胞出现,随着时间的推移,尿液中供者细胞DNA的基因表达强度逐渐减弱,直至术后1个月,只有5例(14 . 3% )受者的尿液中供者细胞DNA的基因表达消失,其中1例(2 0 % )发生急性排斥反应;另外30例(85 . 7% )受者的尿液中仍有供者细胞DNA的基因表达,其中7例(2 3 .3% )发生了急性排斥反应;存活3个月以上发生急性排斥反应9例患者,7例(77 .8% )的尿液标本中能检测到供者细胞DNA ,抗排斥治疗结束后1个月,71 4 %转为阴性;9例肾功能良好的稳定期受者,仅1例(11. 1% )的受者尿液中DYZ -1基因阳性。结论　长期存活的肾移植受者尿中供者细胞DNA的检测可以作为诊断急性排斥反应一种方法。

Diagnosis role of urinary DNA in acute renal rejection after transplantation

Objective To investigate the diagnosis role and value of urinary donor-derived DNA in acute rejection after kidney transplantation. Methods 35 renal transplantation recipients of female were observed, the donors were male. Urine samples were collected regularly. PCR were applied to detect DYZ-1(special gene fragment of Y-chromosome) after DNA were obtained. Results donor cells were detected in urine of all the recipients in 1st day after operation, With the development of disease, the intensity of donor DNA expression in urine was decreased generally. 1 month later, donor cells in urine disappeared only in 5 cases of 35 cases(14.3%), and acute rejection happened in 1 case(20%); other 30 cases(85.7%), donor cells in urine still remained, and 7 cases happened acute rejection(23.3%); in 9 cases of acute rejection after transplation over 3 months, 7 cases were detected the expression of donor cells in urine(77.8%), 1 month following anti-rejection therapy, donor cells in urine were negative in 71.4% cases; in 9 cases of sable renal function, only 1 case was detected positive expression of DYZ-1(11.1%). Conclusion Detect urinary DNA of donor cells would be a new method to diagnose acute renal rejection of long term recipients.