血浆GMP-140与环孢素A谷浓度对肾移植疗效的相关性研究

目的　探讨血浆GMP 140的变化与环孢素A(CsA)谷浓度、疗效三者之间的相关性 ,以寻求一种灵敏的、用于诊断肾移植术后早期排异反应的组合指标 ,以确保肾移植术后的疗效。方法　采用酶联免疫吸附法(ELISA)测定血浆GMP 140水平 ,采用单克隆抗体荧光偏振免疫分析法 (FPIA)测定环孢素A谷浓度 ,对二者之间及其与疗效之间的关系进行了分析和探讨。还对部分患者的CsA和血浆GMP 140进行了术后不同时期的动态监测 ,用以验证分析结果。结果　CsA浓度高于有效治疗浓度范围时 ,具有中毒倾向 ,但其血浆GMP 140水平和正常组相比差异无显著性 (P <0 0 5 ) ;而CsA浓度低于有效治疗浓度范围时 ,存在排异倾向 ,其血浆GMP 140水平显著升高 (P <0 0 5 ) ;当CsA浓度处于有效治疗浓度范围内时 ,亦有部分患者出现GMP 140升高的现象 ,同时伴有肝肾指标异常 ,提示有早期排异的可能性。结论　GMP 140与CsA浓度、疗效三者之间呈密切相关 ,在一定范围内 ,GMP 140随着CsA浓度的升高呈下降趋势。据此 ,综合利用CsA谷浓度和GMP 140测定值 ,可以更加准确地诊断早期排异或中毒反应

A correlation study on plasma level of GMP-140 and the curative effect of trough level of cyclosporin A in renal transplantation

Objective To probe into the correlation among plasma level changes of GMP-140,trough level of cyclosporin A(CsA),and the result of renal transplantation,find out a combined index,sensitive to check the early rejection after renal transplantation,ensuring the transplantation′s result.Methods Plasma level of GMP-140 was determined by ELISA,trough level of cyclosporin A by monoclonal fluorescence polarization immunoassay (FPIA).The relationship between the two levels and the renal transplantation result was analysed.A dynamic monitoring on CsA and GMP-140 levels at various time points after operation was also performed in part of the cases,so as to verify the data.Results When CsA level was higher than the effective dose,poisoning tended to occur;nevertheless,there was no significant difference in plasma GMP-140 levels between the higher-dose-CsA group and the normal group (P>0.05).If CsA level was lower than the effective dose,rejection tended to occur,and plasma level of GMP-140 rose markedly (P<0.05).When CsA level exactly ranged in the effective dose,GMP-140 level also rose in part of cases,concurrently with hepatorenal indices abnormal,this suggesting a possibisity of early rejection.Conclusion A close correlation exists among GMP-140,CsA levels,and the transplantation result;to a certain range,GMP-140 level tends to have a drop along with the CsA level′s going-up.Therefore,comprehensively using the data of CsA′s trough level and GMP-140′s levels,the surgeon can more precisely diagnose the early rejection and/or toxic reaction.