摘要
背景:目前移植肾急性排斥反应依然是导致慢性排斥反应和移植物功能损伤的危险因素,如何无创、快速、准确地进行诊断并及时治疗尤为重要。目的:通过检测尿液中单核细胞趋化蛋白1(monocyte chemoattractant protein-1,MCP-1)水平变化,并结合部分肾组织活检病例,探讨尿MCP-1在肾移植后急性排斥反应早期诊断及治疗后的表达。方法:选择2008-10/2009-02在郑州人民医院肾病移植科住院治疗的慢性肾衰竭患者62例,均接受同种异体肾移植,肾功能稳定组为肾移植后肾功能稳定的42例患者,急性排斥组为肾移植后发生急性排斥反应的20例患者,以同期在郑州人民医院体检中心检查肾功能正常且自愿留取尿样的10例健康人作为对照组。所用肾移植患者均给予常规免疫抑制方案,另外急性排斥组给予抗淋巴细胞免疫球蛋白或甲基强的松龙强化冲击治疗。应用双抗体夹心酶联免疫吸附试验检测尿MCP-1质量浓度变化。结果与结论:与对照组比较,肾功能稳定组尿MCP-1质量浓度无明显变化(P>0.05),急性排斥组尿MCP-1质量浓度显著升高(P<0.01)。与治疗前比较,急性排斥组20例患者经强化治疗后尿MCP-l质量浓度均显著降低(P<0.01),其中17例临床症状缓解、辅助检查恢复正常,尿MCP-1质量浓度接近对照组,3例无效,尿MCP-1质量浓度高于对照组。肾穿刺活检8例,肾脏病理提示均为移植肾急性排斥反应,与急性排斥组治疗前尿MCP-1质量浓度基本相似(P>0.05)。提示尿液中MCP-1水平可早期无创性诊断肾移植后急性排斥反应,可无创性监测治疗效果,其与肾移植后急性排斥反应时肾脏病理损伤可能存在相关性。
BACKGROUND：Presently,acute rejection following renal transplantation remains a risk factor for chronic rejection and graft function injury.How to non-invasive,rapid and exact diagnosis and prompt treatment is important.OBJECTIVE：To investigate early diagnosis and post-treatment expression of urine monocyte chemoattractant protein-1（MCP-1） in the acute rejection after renal transplantation,through detecting the association of the urine MCP-1 variation according to some cases of nephridial tissue biopsy.METHODS：We selected 62 chronic renal failure patients who received renal homotransplantations in the Department of Renal Transplantation of Zhengzhou People＇s Hospital from October 2008 to February 2009.The stable renal function group contained 42 patients with stable renal function following renal transplantation.Acute rejection group contained 20 patients with acute rejection following renal transplantation.We chose 10 patients who examined no abnormalities in the Medical Examination Center of Zhengzhou People＇s Hospital to detect their urine sample as control group.All patients following renal transplantation underwent conventional immunosuppression.In addition,patients in the acute rejection group were treated with antilymphocyte globulin or methylprednisolone reinforced impact therapy.MCP-1 mass concentration changes were measured by double antibodies sandwich enzyme linked immurosorbent assay.RESULTS AND CONCLUSION：Compared with control group,no significant change was determined in urine MCP-1 mass concentration in the stable renal function group（P0.05）.The urine MCP-1 mass concentration was significantly increased in the acute rejection group（P0.01）.Compared with pretreatment,urine MCP-1 mass concentration was significantly decreased following treatment in 20 patients from the acute rejection group（P0.01）.Of them,17 cases had relieved clinical symptom,and normal auxiliary examination,and their urine MCP-1 mass concentration was close to the control group;3 cases were inefficient,whose urine MCP-1 mass concentration was greater than the control group.Eight cases received nephridial tissue biopsy,and kidney pathology demonstrated acute rejection of transplanted kidney,which was similar to urine MCP-1 mass concentration in the acute rejection group prior to treatment（P0.05）.These indicated that the level of MCP-1 in urine can non-invasively diagnose acute rejection following renal transplantation in an early phase,and monitor therapeutic efficacy.This may be associated with renal pathological injury during acute rejection following renal transplantation.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第5期789-793,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
