转化生长因子β1基因型与移植肾的慢性排斥反应

背景：免疫损伤是慢性排斥反应的主要发病机制，与多种免疫相关基因多态性有关，尤其是转化生长因子β1基因多态性更显重要。目前关于转化生长因子β1基因多态性与移植肾慢性排斥反应的关系，不同的学者研究结果各异。 目的：分析供、受者转化生长因子β1基因型与移植肾慢性排斥反应的关系。 设计：前瞻性病例分析。 单位：解放军南京军区福州总医院泌尿外科，全军器官移植中心。 对象：选择2000-06／2001-05在解放军南京军区福州总医院首次施行尸肾移植的受者144例和其中114例的供者65例（另30例缺乏供者血液标本）。手术方案得到医院伦理道德委员会批准。 方法：用序列特异引物聚合酶链反应方法，在肾移植前对肾移植受者（n=144）和其中114例的供者（n=65）进行转化生长因子β1基因型检测。术后对受者进行5年随访，追踪移植肾慢性排斥反应发生情况，分析受者基因型、供者基因型及供、受者基因型组合对移植肾功能的影响。 主要观察指标：①转化生长因子β1不同基因型的肾移植供、受者慢性排斥反应的发生率。②肾移植供、受者转化生长因子β1不同基因型组合慢性排斥反应的发生率。 结果：①高分泌基因型组受者的慢性排斥反应发生率高于中低分泌基因型组（x^2=10．091，P〈0．01）;两组移植肾慢性排斥反应发生率差异无显著性意义（x^2=0．002，P〉0．05）。②供、受者均为高分泌基因型组合的受者移植肾慢性排斥反应发生率高于所有其他基因型组合者（x^2=4．352，P〈0．05）；供、受者均为中低分泌基因型的受者慢性排斥反应发生率低于所有其他基因型组合者（x^2=4．134，P〈0．05）。 结论：肾移植术前同时检测移植供、受者转化生长因子β1基因多态性，有助于术前准确预测和评价移植后远期效果，指导术前做出合理的供、受者匹配。

Relationship between transforming growth factor-beta 1 genotype and chronic renal allograft rejection

BACKGROUND:Immunologic injury is a main pathogenesis of chronic rejection,and it is related to multiple immunological associated-gene polymorphism,in particular,transforming growth factor-β1 gene polymorphism.Recently,there are a lot of researching results of the relationship between TGF-β1 gene polymorphism and chronic rejection.OBJECTIVE:To study the relationship between TGF-β1 genotypes and the chronic renal allograft rejection in recipients and donors.DESIGN:Prospective case analysis.SETTING:Department of Urinary Surgery,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA;General Organ Transplantation Center.PARTICWANTS:A total of 144 recipients and 65 out of 114 donors(another 30 cases did not have the blood preparation)were selected from Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from Jane 2000 to May 2001.The surgical program was approved by the local ethics committee.METHODS:The TGF-β1 genotypes were detected in 144 recipients before renal transplantation and 65 out of 114 donors by sequence-specific primer polymerase chain reaction.The follow-up lasted for 5 years in recipients after surgery to survey chronic renal allografi rejection;furthermore,the effects of genotypes of recipients,genotypes of donors,and the genotype combination on transplanted renal function were analyzed.MAIN OUTCOME MEASURES:(1)Inciderce of chronic renal allograft reiection in recipients and donors with difierent TGF-β1 genotypes;(2)incidence of chronic renal allograft rejection in recipients and donors with TGF-β1 genotype combination.RESULTS:(1)Incidence of chronic renal allograft rejection in recipients with high-secretory TGF-β1 genotype was significantly higher than that in those with moderate-secretory or low-secretory TGF-β1 genotypes(x2=10.091,P<0.01).There were no significant differences in chronic renal allograft rejection among donors with different TGF-β1 genotypes(x2=0.002,P>0.05).(2)Chronic renal allograft rejection occurred in the recipients with high-secretory TGF-β1 genotype,whose donors also had high-secretory TGF-β1 genotype,and the incidence of chronic renal allograft rejection was significantly higher than that in other recipients with TGF-β1 genotype combination(x2=4.352,P<0.05).While the incidence of chronic renal allograft rejection in the recipients with moderate-secretory and low-secretory TGF-β1 genotypes,whose donors also had moderate-secretory and low-secretory TGF-β1 genotypes was significantly lower than that in other recipients with TGF-β1 genotype combination (x2=4.134,P<0.05).CONCLUSION:The TGF-β1 gene polymorphism is detected in the recipients and donors before renal transplantation to benefit for along-term prognostic factor for chronic renal allograft ejection and an ideal genotype combination between recipients and donors.