CAJ | 학술논문

目的观察肾移植术后外周血单个核细胞(PBMC)转化生长因子β_1,(TGF-β_1)mRNA表达,探讨巨细胞病毒(CMV)感染对远期肾功能的影响和可能机制.方法选择2000年3月至2005年12月期间手术受者为研究对象,根据术后CMV感染与发病情况,将完成3年随访的96例受者分成3组:A组为有症状的活动性感染(n=33),B组为无症状的活动感染(n=33),C组为无活动性感染(n=30).分析CMV感染、PBMC内TGF-β_1,mRNA表达和血清肌酐(Scr)三者之间关系,对6例肾功能异常者实施移植肾活检术.结果术后6月3组Scr水平无明显差异(P>0.05),有症状的A组PBMC的TGF-β_1,mRNA表达水平明显较无症状的B组和C组高(均P<0.01),而术后3年A组Scr水平明显较其它两组高(P<0.01),A组有10例(10/33)出现肾功能异常,发生率较B组(3/33)和C组(3/30)显著增高(均P<0.05).3组肾功能异常者(16例)在术后6月PBMC的TGF-β_1,mRNA表达水平较肾功能正常者(80例)明显增高(P<0.01).肾功能异常患者组织病理提示以间质纤维化、肾小管萎缩改变为主,符合慢性移植肾肾病(CAN)的病理改变.结论肾移植术后有症状CMV感染是诱发CAN的重要因素,TGF-β_1可能介导了移植肾的损伤,早期监测PBMC内TGF-β_1 mRNA表达对防治CAN发生、发展有一定的临床意义.
목적 관찰신이식술후외주혈단개핵세포(PBMC)전화생장인자β_1,(TGF-β_1)mRNA표체,탐토거세포병독(CMV)감염대원기신공능적영향화가능궤제.방법 선택2000년3월지2005년12월기간수술수자위연구대상,근거술후CMV감염여발병정황,장완성3년수방적96례수자분성3조:A조위유증상적활동성감염(n=33),B조위무증상적활동감염(n=33),C조위무활동성감염(n=30).분석CMV감염、PBMC내TGF-β_1,mRNA표체화혈청기항(Scr)삼자지간관계,대6례신공능이상자실시이식신활검술.결과 술후6월3조Scr수평무명현차이(P>0.05),유증상적A조PBMC적TGF-β_1,mRNA표체수평명현교무증상적B조화C조고(균P<0.01),이술후3년A조Scr수평명현교기타량조고(P<0.01),A조유10례(10/33)출현신공능이상,발생솔교B조(3/33)화C조(3/30)현저증고(균P<0.05).3조신공능이상자(16례)재술후6월PBMC적TGF-β_1,mRNA표체수평교신공능정상자(80례)명현증고(P<0.01).신공능이상환자조직병리제시이간질섬유화、신소관위축개변위주,부합만성이식신신병(CAN)적병리개변.결론 신이식술후유증상CMV감염시유발CAN적중요인소,TGF-β_1가능개도료이식신적손상,조기감측PBMC내TGF-β_1 mRNA표체대방치CAN발생、발전유일정적림상의의.
Objective To evaluate the effect of cytomegalovirus (CMV) infection following kidney transplantation on long-term renal function and its mechanism. Methods Ninety-six patients undergoing kidney transplantation between March 2000 and December 2005, who completed a 3-year follow-up investigation, were divided into 3 groups according CMV-pp65 antigenemia and clinical symptoms. Group A consisted of 33 recipients with symptomatic active CMV infection, group B included 33 with asymptomatic active CMV infection and group C included 30 with inactive infection. The relation of CMV infection, transforming growth factor-β_1 (TGF-β_1) mRNA in the peripheral blood mononuclear cells (PBMCs) and serum creatinine (Scr) were analyzed, and the grafts in 6 cases with renal dysfunction were biopsied. Results The expression of TGF-(β_1 mRNA in PBMCs was significantly higher in group A than in the other two groups 6 months after the transplantation (P<0.01), while Scr levels showed no significant difference between the 3 groups(P>0.05). Three years later, Scr levels in group A were significantly increased as compared with those in the other two groups (P<0.01), and the rate of renal dysfunction in group A (10/33) was significantly higher than those in group B (3/33) and C(3/30) (P<0.05). In the 16 with renal dysfunction, the expression of TGF-β_1 mRNA in PBMCs significantly higher than that in the other 80 patients with normal renal function (P<0.01). Renal allograft biopsies demonstrated mild or severe interstitial fibrosis, tubular atrophy and mononuclear cell infiltration in the 6 patients with renal graft dysfunction, supporting the diagnosis of chronic allograft nephropathy (CAN). Conclusion Symptomatic active CMV infection in renal allograft recipients is an important factor contributing to the occurrence of CAN. Monitoring of TGF-β_1 mRNA expression in PBMCs proves useful in identifying patients at risk of CAN.