CAJ | 학술논문

目的观察亲属活体肾移植后受者免疫细胞亚群的动态变化.方法首次肾移植受者16例,应用抗CD25单克隆抗体行免疫诱导,免疫抑制维持方案为他克莫司+吗替麦考酚酯+皮质激素.术前及术后6个月内流式多点检测外周血中T淋巴细胞、B淋巴细胞、自然杀伤细胞(NK细胞)重要亚群的比例及其相关重要分子的表达.结果 T淋巴细胞在术后3d明显降低,此后逐渐回升至术前水平.CD4+、CD8+T淋巴细胞表面CD25表达及CD4+ CD25high CD127low调节性T淋巴细胞明显降低,术后3个月开始回升,至术后6个月恢复至术前水平.B淋巴细胞比例术后1个月内升高至术前的1.8～2.1倍,术后3个月恢复；CD19+ CD5+B淋巴细胞逐渐下降,术后6个月降至术前的45％；记忆性B淋巴细胞逐渐升高至术前的1.3倍；B淋巴细胞活化因子受体(BAFF-R)的表达一直维持在较高水平(91.7％～97.9％)；前生发中心、生发中心细胞比例持续下降.NK细胞比例逐渐下降至术前的44％,但NK细胞表面抑制性受体(NKG2A)与活化性受体(NKG2D)比值明显升高.结论效应性T淋巴细胞和调节性T淋巴细胞表面CD25表达在术后3个月开始恢复；术后早期B淋巴细胞比例明显增加,其活化可能不受抑制；NK细胞比例明显降低,且杀伤功能可能减弱.外周免疫细胞亚群的系统动态监测有助于了解肾移植受者术后的免疫风险.
목적 관찰친속활체신이식후수자면역세포아군적동태변화.방법 수차신이식수자16례,응용항CD25단극륭항체행면역유도,면역억제유지방안위타극막사+마체맥고분지+피질격소.술전급술후6개월내류식다점검측외주혈중T림파세포、B림파세포、자연살상세포(NK세포)중요아군적비례급기상관중요분자적표체.결과 T림파세포재술후3d명현강저,차후축점회승지술전수평.CD4+、CD8+T림파세포표면CD25표체급CD4+ CD25high CD127low조절성T림파세포명현강저,술후3개월개시회승,지술후6개월회복지술전수평.B림파세포비례술후1개월내승고지술전적1.8～2.1배,술후3개월회복；CD19+ CD5+B림파세포축점하강,술후6개월강지술전적45％；기억성B림파세포축점승고지술전적1.3배；B림파세포활화인자수체(BAFF-R)적표체일직유지재교고수평(91.7％～97.9％)；전생발중심、생발중심세포비례지속하강.NK세포비례축점하강지술전적44％,단NK세포표면억제성수체(NKG2A)여활화성수체(NKG2D)비치명현승고.결론 효응성T림파세포화조절성T림파세포표면CD25표체재술후3개월개시회복；술후조기B림파세포비례명현증가,기활화가능불수억제；NK세포비례명현강저,차살상공능가능감약.외주면역세포아군적계통동태감측유조우료해신이식수자술후적면역풍험.
Objective To observe the dynamic change of peripheral immune cell subsets in living-related kidney transplant (LRKT) recipients.Method Sixteen de novo LRKT recipients were enrolled in this study.The induction therapy was given (anti-CD25 monoclonal antibody),and the maintenance immunosuppressive regimen consisted of tacrolimus,mycophenloate mofetil and steroids.Subpopulations of T cells,B cells and NK cells as well as the expression of relative cell surface molecules were monitored by using flow cytometry at multiple time points before/after transplant.Examination data prior to transplant was defined as baseline level.Results The proportion of T cells was decreased within 3 days after transplantation,and then increased steadily to 1.2 times of the baseline at month 6.The CD25 expression in CD4+ and CD8 + T cells and the proportion of CD4+CD25highCD127low regulatory T cells were decreased significantly within three months post-transplant,and recovered to the baseline at month 6.CD19+ B cells were significantly increased by 1.8-2.1 times within one month post-transplant,and recovered to the baseline at month 3.CD5+ CD19+ B cells were decreased steadily after transplantation and dropped to 45％ at month 6.Memory B cells were increased gradually by 1.3 times after transplantation.The BAFF-R expression in B cells maintained at high level (91.7％-97.9％) within six months post-transplant.The germinal center (GC) founder cells (IgD+ CD38++) and GC B cell subpopulation (IgD-CD38++) were consistently decreased after transplantation.NK cells were decreased gradually to 44％ at month 6.NKG2A/NKG2D was increased significantly by 2.4-7.1 times within six months.Conclusion The CD25 expression in effector T cells and regulatory T cells began to recover after three months post-transplant.B cells proportion was significantly increased early after transplant without inhibition of activation.NK cells were decreased dramatically after transplantation and the killer function might be impaired.Dynamic monitoring of immune cell subsets may facilitate estimating immune risk of rejection and infection.