非清髓性供者造血干细胞移植对肾移植受者免疫功能的影响

目的：探讨肾移植受者进行非清髓性供者造血干细胞移植诱导免疫耐受、降低排斥反应的有效性、安全性。方法：根据ABO／Rh血型相同及HLA氨基酸残基配型相容原则，将同期等待肾移植的96例女性慢性肾功能衰竭患者随机分为观察组和对照组，各48例。观察组接受同一供体的骨髓一肾联合移植；对照组接受上述供体的肾移植。应用流式细胞术检测外周血CD3＋、CD4＋．CD8＋、CD19＋、CD4＋CD25＋细胞百分比，应用酶联免疫吸附法检测IL-10、TNF-d浓度。结果：移植后随着时间延长，观察组CD3＋．CD4＋、CD19＋细胞百分比及TNF吨浓度持续降低，与对照组相比，60d后CD3＋、CD4＋．CD19＋下降最明显（P〈0．05），之后稳定在一个水平；观察组CD8＋降低不明显，但CD4＋／CD8＋比值明显降低；观察组CD4＋CD25＋百分比及IL-10浓度持续升高，与对照组相比，CD4＋CD25＋百分比90d时升高最明显（P〈0．05），IL-10浓度30d时升高最为明显（P〈0．05）。观察组急性排斥发生率为12％，对照组为29％，两组比较，差异有统计学意义（P〈0．05）。结论：供体特异性造血干细胞移植是一种安全、有效地诱导肾移植免疫耐受的临床治疗方法，能够降低排斥反应的发生，但更深层次的免疫机制有待进一步探讨。

Effects of immune function about non-myeloablative hematopoietic stem cell transplantation from the same donors to patient with renal transplantation

Objective： To explore the effectiveness and security of immunologie tolerance and reducing rejection induced by non-myeloablative hematopoietic stem cell transplantation from the same donors in renal transplant recipients. Methods： According to ABO/Rh blood type and amino acid residue matching of HLA, 96 cases of female patients with ehoric renal failure （CRF） who were waiting for kidney transplantation were divided into observation group （48 cases） and control group （48 cases）. In observation group, the patients were received the same donor＇s bone marrow-kidney transplantation; in control group, the patients were received the kidney transplantation only. The cell percentages of CD3＋, CD4＋, CD8＋, CD19＋, CD4＋ CD25＋ and the concentration of IL-10, TNF-α in the peripheral blood of all patients were detected by the flow cytometry （FCM） and enzyme-linked immunsorbent assay （ELISA） respectively. Results： Compared with the patients in the eontrol group, the cell percentages of CD3＋, CD4＋, CD19＋ and the concentration of TNF-α in the patients of observation group declined continually after transplantation（P〈0.05）, and the decline achieved the minimum in the 60th days, then sustained in a level, and the ratio of CD4＋/CD8＋ declined, too. However, the cell percentages of CD4＋CD25＋ and the concentration of IL-10 rised continually, the former achieved the maximum in the 90th days and the latter in the 30th after transplantation in the observation group （all P〈0.05）. In the observation group, the rate of acute rejection was 12%, and was 29% in control group, there was a significant differeee in the two groups （P〈0.05）. Conclusion： Non-myeloablative hematopoietie stem cell transplantation can reduce the occurrence of rejection, and it is a safe and effective clinical treatment method which can induce the kidney transplant immune tolerance. However, its deeper immune mechanism needs further discussion.