CAJ | 학술논문

目的异体手移植术后患者外周血淋巴细胞亚群的变化和通过CD+3细胞数量的监测指导抗胸腺细胞球蛋白（antithymocyte globulin ,ATG）的用量。方法提取患者的外周血细胞，加入三荧光和双荧光标记的鼠抗人单克隆抗体CD3/CD4/CD8，CD3/CD（16+56），CD3/HLA - DR，用流式细胞分析仪测定。结果术后1周内CD+3，CD+4，CD+8 T细胞，活化T细胞［CD+3/CD(16+56)+,CD+3/HLA - DR+］，静止性T细胞［CD+3/CD(16+56)，CD+3/HLA - DR-］明显下降，1周后除CD+8细胞比术前升高外，其余均恢复至术前水平；CD4/CD8比值持续呈低水平； NK细胞（CD-3/CD(16+56)+）术后1 d内显著升高，但术后第2天就直线下降并维持在低水平。结论异体手移植中应用ATG的剂量以（2 mg*kg-1*d-1）较为适宜，其CD+3 细胞数量的监控范围为0.1 × 109 ～ 0.4 × 109/L。说明T淋巴细胞亚群的监测有助于判断手的存活和观察排斥反应的发生。免疫抑制剂对移植术后的T淋巴细胞亚群有明显的影响。
목적이체수이식술후환자외주혈림파세포아군적변화화통과CD+3세포수량적감측지도항흉선세포구단백（antithymocyte globulin ,ATG）적용량。방법제취환자적외주혈세포，가입삼형광화쌍형광표기적서항인단극륭항체CD3/CD4/CD8，CD3/CD（16+56），CD3/HLA - DR，용류식세포분석의측정。결과술후1주내CD+3，CD+4，CD+8 T세포，활화T세포［CD+3/CD(16+56)+,CD+3/HLA - DR+］，정지성T세포［CD+3/CD(16+56)，CD+3/HLA - DR-］명현하강，1주후제CD+8세포비술전승고외，기여균회복지술전수평；CD4/CD8비치지속정저수평； NK세포（CD-3/CD(16+56)+）술후1 d내현저승고，단술후제2천취직선하강병유지재저수평。결론이체수이식중응용ATG적제량이（2 mg*kg-1*d-1）교위괄의，기CD+3 세포수량적감공범위위0.1 × 109 ～ 0.4 × 109/L。설명T림파세포아군적감측유조우판단수적존활화관찰배척반응적발생。면역억제제대이식술후적T림파세포아군유명현적영향。
Objective　To investigate the changes of lymphocyte subsets in the peripheral blood of patients with hand allotransplantation and determine the dosage of antithymocyte globulin (ATG) by means of CD+3 T cell count monitoring. Methods　The lymphocytes gained from the peripheral blood of the patients in different intervals after hand allotransplantation were immunologically labeled by triple color fluorescent monoclonal antibodies CD3/CD4/CD8 and dual color fluorescent monoclonal antibodies CD3/CD（16＋56）and CD3/HLA - DR. Flow cytometry (FCM) was used to determine CD3, CD4, CD8, CD3/CD（16＋56）, and CD3/HLA - DR levels. Results　The levels of CD+3，CD+4，CD+8 T - lymphocytes, the activated T - lymphocyte ［CD+3/CD(16+56)+, CD+3/HLA - DR+］, the silent T - lymphocyte ［CD+3/CD(16+56)+, CD+3/HLA - DR-］ decreased significantly within the first post - transplantation week and then gradually returned to the pre - transplantation level, except for CD+8 T - lymphocyte which increased to a level even higher than the pre - transplantation level. The CD4/CD8 ratio remained at low level. Nature killer cell （CD-3/CD(16+56)+）increased significantly at the first postoperative day and then dropped quickly and maintained at low level. Conclusions　Administration of ATG at the dosage of 2 mg*kg-1*d-1 was sufficient to maintain the level of CD+3 T cells at 0.1×109～0.4×109/L in patients with hand allotransplantation. Monitoring of T - lymphocyte subsets is helpful for observation of survival and rejection in hand allotransplantation. The immunosuppressive agents have significant effects on the T - lymphocyte subsets in the patients.