实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2014年
6期
344-349
,共6页
房爱芳%张淦%李永海%向莹%明长生%张伟杰
房愛芳%張淦%李永海%嚮瑩%明長生%張偉傑
방애방%장감%리영해%향형%명장생%장위걸
西罗莫司%他克莫司%调节性T细胞%调节性B细胞%酶联斑点免疫试验%免疫状态
西囉莫司%他剋莫司%調節性T細胞%調節性B細胞%酶聯斑點免疫試驗%免疫狀態
서라막사%타극막사%조절성T세포%조절성B세포%매련반점면역시험%면역상태
Sirolimus%Tacrolimus%Treg%Breg%Enzyme-linked immunospot assay%Immune condition
目的通过比较两种不同免疫抑制方案对肾移植术后受者免疫状态的影响，以寻找有利于移植物长期存活的免疫抑制方案。方法研究纳入亲属活体肾移植受者18例，肾功能稳定。根据应用免疫抑制方案的不同分为两组：西罗莫司（SRL）组8例，方案为SRL+吗替麦考酚酯（MMF）+泼尼松（Pred）；他克莫司（TAC）组10例，方案为TAC+MMF+Pred；两组用药时间均超过1年。相应的亲属活体肾移植供者作为空白对照。采用流式细胞技术检测3组外周血调节性T细胞（Treg）（CD4+CD25+Foxp3+）、调节性B细胞（Breg）（CD19+CD5+CD1d+）占外周血淋巴细胞的比例，采用酶联斑点免疫试验（ELISPOT）检测SRL组、TAC组肾移植受者外周血淋巴细胞经其相应供者外周血淋巴细胞特异刺激后，分泌特异性细胞因子γ-干扰素（IFN-γ）、白细胞介素-10（IL-10）的单个细胞频数。结果 SRL组肾移植受者外周血CD4+CD25+Foxp3+ Treg占总CD4+T细胞的比例为（6.68±0.42）％，TAC组为（3.59±0.47）％，空白对照组为（6.59±0.36）％，SRL组和空白对照组显著高于TAC组（均P＜0.05），SRL组与空白对照组比较差异无统计学意义（P＞0.05）。SRL组外周血Breg（CD19+CD5+CD1d+）占CD19+ B细胞的比例为（16.43±3.56）％，TAC组为（13.09±1.64）％，空白对照组为（16.58±1.31）％，3组之间两两比较差异均无统计学意义（均P＞0.05）。ELISPOT检测SRL组分泌IFN-γ的细胞频数为（117.00±21.54）/500000， TAC组为（126.00±24.08）/500000；分泌IL-10的细胞频数SRL组为（347.00±55.29）/500000，TAC组为（249.00±58.97）/500000，两组比较差异均无统计学意义（均P＞0.05）。结论长期应用以SRL为基础的免疫抑制方案并不影响Treg占外周血淋巴细胞的比例，而应用以TAC为基础的免疫抑制方案会降低外周血Treg的数量；两种方案都不影响Breg占外周血CD19+B细胞的比例，而且也不影响受者对供者的特异性反应性。
目的通過比較兩種不同免疫抑製方案對腎移植術後受者免疫狀態的影響，以尋找有利于移植物長期存活的免疫抑製方案。方法研究納入親屬活體腎移植受者18例，腎功能穩定。根據應用免疫抑製方案的不同分為兩組：西囉莫司（SRL）組8例，方案為SRL+嗎替麥攷酚酯（MMF）+潑尼鬆（Pred）；他剋莫司（TAC）組10例，方案為TAC+MMF+Pred；兩組用藥時間均超過1年。相應的親屬活體腎移植供者作為空白對照。採用流式細胞技術檢測3組外週血調節性T細胞（Treg）（CD4+CD25+Foxp3+）、調節性B細胞（Breg）（CD19+CD5+CD1d+）佔外週血淋巴細胞的比例，採用酶聯斑點免疫試驗（ELISPOT）檢測SRL組、TAC組腎移植受者外週血淋巴細胞經其相應供者外週血淋巴細胞特異刺激後，分泌特異性細胞因子γ-榦擾素（IFN-γ）、白細胞介素-10（IL-10）的單箇細胞頻數。結果 SRL組腎移植受者外週血CD4+CD25+Foxp3+ Treg佔總CD4+T細胞的比例為（6.68±0.42）％，TAC組為（3.59±0.47）％，空白對照組為（6.59±0.36）％，SRL組和空白對照組顯著高于TAC組（均P＜0.05），SRL組與空白對照組比較差異無統計學意義（P＞0.05）。SRL組外週血Breg（CD19+CD5+CD1d+）佔CD19+ B細胞的比例為（16.43±3.56）％，TAC組為（13.09±1.64）％，空白對照組為（16.58±1.31）％，3組之間兩兩比較差異均無統計學意義（均P＞0.05）。ELISPOT檢測SRL組分泌IFN-γ的細胞頻數為（117.00±21.54）/500000， TAC組為（126.00±24.08）/500000；分泌IL-10的細胞頻數SRL組為（347.00±55.29）/500000，TAC組為（249.00±58.97）/500000，兩組比較差異均無統計學意義（均P＞0.05）。結論長期應用以SRL為基礎的免疫抑製方案併不影響Treg佔外週血淋巴細胞的比例，而應用以TAC為基礎的免疫抑製方案會降低外週血Treg的數量；兩種方案都不影響Breg佔外週血CD19+B細胞的比例，而且也不影響受者對供者的特異性反應性。
목적통과비교량충불동면역억제방안대신이식술후수자면역상태적영향，이심조유리우이식물장기존활적면역억제방안。방법연구납입친속활체신이식수자18례，신공능은정。근거응용면역억제방안적불동분위량조：서라막사（SRL）조8례，방안위SRL+마체맥고분지（MMF）+발니송（Pred）；타극막사（TAC）조10례，방안위TAC+MMF+Pred；량조용약시간균초과1년。상응적친속활체신이식공자작위공백대조。채용류식세포기술검측3조외주혈조절성T세포（Treg）（CD4+CD25+Foxp3+）、조절성B세포（Breg）（CD19+CD5+CD1d+）점외주혈림파세포적비례，채용매련반점면역시험（ELISPOT）검측SRL조、TAC조신이식수자외주혈림파세포경기상응공자외주혈림파세포특이자격후，분비특이성세포인자γ-간우소（IFN-γ）、백세포개소-10（IL-10）적단개세포빈수。결과 SRL조신이식수자외주혈CD4+CD25+Foxp3+ Treg점총CD4+T세포적비례위（6.68±0.42）％，TAC조위（3.59±0.47）％，공백대조조위（6.59±0.36）％，SRL조화공백대조조현저고우TAC조（균P＜0.05），SRL조여공백대조조비교차이무통계학의의（P＞0.05）。SRL조외주혈Breg（CD19+CD5+CD1d+）점CD19+ B세포적비례위（16.43±3.56）％，TAC조위（13.09±1.64）％，공백대조조위（16.58±1.31）％，3조지간량량비교차이균무통계학의의（균P＞0.05）。ELISPOT검측SRL조분비IFN-γ적세포빈수위（117.00±21.54）/500000， TAC조위（126.00±24.08）/500000；분비IL-10적세포빈수SRL조위（347.00±55.29）/500000，TAC조위（249.00±58.97）/500000，량조비교차이균무통계학의의（균P＞0.05）。결론장기응용이SRL위기출적면역억제방안병불영향Treg점외주혈림파세포적비례，이응용이TAC위기출적면역억제방안회강저외주혈Treg적수량；량충방안도불영향Breg점외주혈CD19+B세포적비례，이차야불영향수자대공자적특이성반응성。
Objective To assess the impacts of sirolimus(SRL)and tacrolimus(TAC)on immune condition <br> in renal transplant recipients,in order to find the optimal immunosuppressive regimens. Methods According to the different immunosuppressive regimens,18 living donor renal transplant recipients with stable renal function were divided into two groups:SRL group(n=8)on SRL + mycophenolate mofetil(MMF)+ prednisone(Pred) and TAC group(n=10)on TAC+MMF+Pred. All the patients received the immunosuppressive regimens for at least one year. The living donors were chosen as the blank control. All the subjects of the 3 groups were examined for the proportion of Regulatory T(Treg)cells(CD4+CD25+Foxp3+)and Regulatory B(Breg)cells(CD19+CD5+CD1d+) in their peripheral blood mononuclear cells(PBMCs)by flow cytometry. After stimulation by the corresponding donor's PBMCs,the recipient's PBMCs were measured through the production of interferon-γ(IFN-γ)and interleukin-10(IL-10)of the recipient's PBMCs of SRL group and TAC group were measured by enzyme-linked immunospot assay(ELISPOT). Results The proportion of CD4+ CD25+ Foxp3+ Treg in the SRL group,TAC group and blank control group were(6.68±0.42)%,(3.59±0.47)%and(6.59±0.36)%,respectively. The ratio of the SRL group and blank control group were significantly higher than that of the TAC group(both P<0.05), and there was no statistically significant difference between the SRL group and blank control group(P>0.05). The proportion of CD19+CD5+CD1d+B cells in the SRL group,TAC group and blank control group were(16.43±3.56)%, (13.09±1.64)%and(16.58±1.31)%,respectively. There were no statistically significant differences among the three groups(all P>0.05). The frequency of the cellsproducing IFN-γin the SRL group and TAC group detected by ELISPOT were(117.00±21.54)/ 500 000 and(126.00±24.08)/ 500 000, without significant difference (P>0.05). The frequency of the cellsproducing IL-10 in the SRL group and TAC group were(347.00±55.29)/500 000 and(249.00±58.97)/ 500 000,without significant difference(P>0.05). Conclusion The regimen based on SRL shows no effect on the percentage of Treg of PBMC in long-term renal transplant recipients,however, the regimen based on TAC reduces the percentages. Meanwhile,both the regimens have no impact on the proportion of Breg in the peripheral CD19+B cells and on the donor-specific immune reaction.
