利用肾移植受者术后血清可溶性CD30预测早期急性排异反应_临床医学论文.docVIP

利用肾移植受者术后血清可溶性CD30预测早期急性排异反应_临床医学论文 利用肾移植受者术后血清可溶性CD30预测早期急性排异反应_临床医学论文 【摘要】 目的: 评价利用肾移植受者术后血清可溶性CD30(sCD30)水平预测急性排异反应的可行性. 方法： 利用ELISA方法分别在术前、术后5 d和10 d检测231名肾移植受者的血清sCD30水平，根据肾移植受者术后1 mo内临床表现将他们分为三组：急性排异反应组(AR，n＝49),肾功能延迟恢复组(DGF，n＝11) 和正常组(UC，n＝171). 结果: 231名肾移植受者的血清sCD30水平由术前的(178±79) U/mL分别降至术后5 d的(52±30) U/mL和术后10 d的［(9±5) U/mL,0.001］. AR组术后5 d的sCD30水平为(92±27) U/mL，高于UC组(41±20) U/mL和DGF组［(48±18) U/mL,0.001］. 而术前和术后10 d的sCD30水平在三组患者之间的差异无统计学意义. ROC曲线分析结果表明，利用术后5 d sCD30水平可以预测近期内即将出现的急性排异反应(曲线下面积0.95).并且，根据ROC曲线分析得出： 将65 U/mL作为临界点可以较好的预测急性排异反应(特异性91.8%，敏感性87.1%). 结论: 检测肾移植受者术后5 d的血清sCD30水平可以预测移植后早期出现的排异反应. 【关键词】 可溶性CD30；移植物排异；敏感性与特异性；肾移植　　【Abstract】 AIM: To evaluate the feasibility of postred and thirtyone patients were included into the study, whose serum levels of sCD30 were detected by ELISA before and after transplantation. Then, they were divided into three groups according to the clinical features one month posttransplantation: acute rejection group (AR,n=49), delayed graft function group (DGF,n=11) and uncomplicated course group (UC,n=171). RESULTS: Significant decrease of sCD30 was detected on day 5 and 10 posttransplantation respectively［ (178±79） U/mL vs (52±30) U/mL, (9±5) U/mL,0.001］. Compared with Group UC and DGF, patients of Group AR had higher sCD30 values on day 5 post［(92±27) U/mL vs (41±20) U/mL and (48±18) U/mL, 0.001)］. However, sCD30 levels were not different between three groups before transplantation and on day 10 postOC curve 0.95). According to ROC curve, 65 U/mL was the optimal operational cutoff level to predict impending graft rejection (specificity=91.8%, sensitivity=87.1%). CONCLUSION: Measurement of sCD30 on 5 day posttransplantation might offer a noninvasive means to recognize patients at risk of impending acute graft rejection during early posttransplantation period. 　　【Keywords】 soluble CD30; graft rejection; sensitivity and specificity; kidney transplantation 　　0 引言 　　新型免疫抑制剂的出现大大降低了急性排异反应的发生率，但是，急性排异反应仍旧是引起早期移植肾失功和慢性移