检测肾移植受者CD4~+T淋巴细胞内三磷腺苷的意义

目的探讨检测CD4+T淋巴细胞内三磷腺苷(ATP)水平用于评价肾移植受者细胞免疫功能的价值。方法采用植物血凝素刺激、单克隆抗体包被免疫磁珠分离CD4+T淋巴细胞,以荧光试剂标记,测定27例肾移植受者(研究组)的术前,术后3d、7d、14d、30d以及发生感染时的CD4+T淋巴细胞内ATP水平,并以14名健康人作对照(对照组)。研究组患者术后均采用抗人T细胞CD3鼠单抗(OKT3)诱导治疗,并予免疫抑制剂治疗,其中21例采用以环孢素(CsA)为基础的三联用药方案,6例采用以他克莫司(FK506)为基础的三联用药方案,比较采用不同用药方案患者的ATP水平,采用Pearson相关分析评估肾移植患者ATP水平与环孢素或他克莫司血药浓度的关系。结果肾移植受者术前CD4+T淋巴细胞内ATP水平为(382±187)ng/ml,明显低于正常成人的(496±116)ng/ml(P0.05),术后7d降至最低,14d开始回升,30d时仍低于术前水平(P0.01)。3例术后并发肺部感染者,其CD4+T淋巴细胞内ATP水平下降,病情加重时下降更加明显,感染控制后有所回升。采用环孢素三联方案治疗的患者各时点的ATP水平与采用他克莫司三联方案治疗的患者比较差异无统计学意义。肾移植受者的ATP水平与上述两药血药浓度变化无关。结论测定肾移植受者CD4+T淋巴细胞内ATP水平可反映患者的整体细胞免疫状态,指导临床制定个体化治疗方案。

Applications of the examination for CD4+ T cells' ATP in renal transplant recipient

Objective The ImmuKnow assay measures cell-mediated immunity and is able to discern between conditions of overimmunosuppression and underimmunosuppression.The aim of this study was to evaluate the ImmuKnow assay in the evaluation of the immune function in kidney transplant recipients and to assess its correlation with the patients＇ clinical and biochemical status.Methods The ATP level of CD4＋ T cells was measured by using Immuknow kit and equipments produced by CYLEX.The ATP levels of CD4＋ T cells were measured in 27 recipients before and 3,7,14,30 d after operation,and at the time of infection.The normal value for this assay was developed from 14 health adults.OKT3 induction followed CsA （n=21） or FK506 （n=6） maintenance immunosuppressive therapy were given to all recipients.The ATP levels were compared in patients with different immunosuppressant treatment.The relation between ATP levels in kidney recipients and blood drug level were evaluated using Pearson＇s correlation test.Results ATP concentrations in CD4＋ T cells of the recipients undergoing renal transplantation were （382±187） ng /ml before operation,significantly lower than those in normal adults （496±116] ng /ml,P 0.05）.The ATP concentration reached the lowest about day 7 after operation,then increased slowly on the postoperative day 14,but significantly lower than that pre-transplantation by day 30 （P 0.01）.In the recipients with lung infection,ATP concentrations were decreased,and increased after effective treatment.There was no significant difference in ATP concentrations between FK506-based treatment group and CsA-based treatment group.Also,no direct correlation between ATP concentrations and drug concentrations was observed in whole blood.Conclusion The examination of ATP in CD4＋ T cells could reflect the status of cellular immunity and guide the clinical individualized immunosuppressive therapy.