溶解性CD30水平检测在肾移植中的应用

背景:体外实验数据表明了在同种异体移植免疫反应中存在CD30阳性的T细胞.目的:通过对肾移植手术前后患者血清溶解性CD30分子的检测,结合临床排斥反应的发生情况,分析其对于评估受者术后免疫状态、监测急性排斥反应发生以及预后判断中的价值.设计、时间及地点:临床病例分析,于2004-04/2007-03在江苏省人民医院完成.对象:肾移植患者153例,男103例,女50例,平均年龄37岁.方法:分别采集移植前 (未使用免疫抑制剂)和移植后第0,1,3,5,7,14,21,28天移植受者外周血3 mL,分离血清-20 °C保存,使用由BenderMedSystems提供的溶解性CD30 细胞因子ELISA 检测试剂盒,检测各样本溶解性CD30水平.主要观察指标:移植前后溶解性CD30与排斥反应的相关性.结果:对17例发生急性排斥患者与136例未发生排斥患者的术前溶解性CD30水平进行比较,排斥组平均113.2 U/mL,未排斥组83.2 U/mL,两组间差异有显著性意义(P < 0.01);术后5 d内两组间无明显差异(P > 0.05);而从术后5 d开始,排斥组与未排斥组具有明显差异(P < 0.01).急性排斥反应发生和排斥缓解的时间与溶解性CD30水平之间无相关性(P > 0.05).ROC曲线分析结果表明,术后5 d溶解性CD30水平可以很好的诊断急性排斥反应,曲线下面积为0.850,理想的临界值为100 U/mL,其特异性为85.0%,敏感性为83.6%.预后结果显示,术前溶解性CD30阳性患者移植肾存活率明显低于阴性患者(P < 0.01).结论:肾移植患者溶解性CD30水平对于预测急性排斥反应及对预后的判断均有一定的价值.

Application of soluble CD30 level measurement in kidney transplantation

BACKGROUND: Some studies in vitro have reported that there are CD30 positive T cells in immunological response of allogenic transplantation.OBJECTIVE: To detect the relationship between the level of serum CD30 (sCD30) and clinical rejection in the patients with or without kidney transplantation, and analyze the importance of sCD30 in the estimation of immune state, monitor of acute rejection, and judgment of prognosis. DESIGN, TIME AND SETTING: Clinical case analysis study was performed at Jiangsu People's Hospital between April 2004 and March 2007. PARTICIPANTS: 153 kidney transplantation cases comprising 103 males and 50 females, averagely aged 37 years. METHODS: 3 mL peripheral blood was obtained from recipients before transplantation (without immunosuppressive agent) and at 0, 1, 3, 5, 7, 14, 21, and 28 days. Serum was isolated from obtained blood and placed at -20 ℃. Soluble CD30 levels were detected using CD30 cytokine ELISA kit supplied by BenderMedSystems. MAIN OUTCOME MEASURE: The relation between the soluble CD30 levels and rejection prior to and following transplantation.RESULTS: There was a significant relation in the sCD30 level between the patients with (n=17) and without acute rejection (n=136). The CD30 levels were 113.2 U/mL in the rejection group and 83.2 U/mL in the non-injection group (P < 0.01). No significant difference was determined between both groups in 5 days following surgery (P > 0.05). Significant difference were detected between both groups from 5 days following surgery (P < 0.01). There was no relation between the soluble CD30 level and the time of rejection and release after kidney transplantation (P > 0.05). Receiver operating characteristic (ROC) curve demonstrated that soluble CD30 levels on day 5 post-transplantation could predict acute rejection (area under ROC curve: 0.850). Meanwhile, 100 U/mL was the optimal operational cut-off level to predict rejection (specificity: 85.0%; sensitivity: 83.6%). The patients with positive of soluble CD30 level showed a lower survival rate than those with negative CD30 level (P < 0.01). CONCLUSION: The soluble CD30 levels contributed to predictive the acute rejection and prognosis of kidney transplantation.