【摘要】 目的探讨急性排斥反应发生的机制,寻找适合临床早期诊断急性排斥反应(AR)的敏感指标。方法采用免疫组织化学法检测移植肾组织中穿孔素和颗粒酶B的表达;利用流式细胞仪检测法和免疫细胞化学ABC法,检测外周血淋巴细胞中穿孔素和颗粒酶B的表达。结果AR的移植肾病理标本均100%表达穿孔素和颗粒酶B,二者的表达情况类似,主要定位于肾小管上皮细胞和间质淋巴细胞的胞浆和胞膜,与病理分级呈正相关,颗粒酶B的相关程度更好。发生AR的患者外周血淋巴细胞中穿孔素和颗粒酶B的表达较肾功能稳定的患者有明显的升高,而且在出现明显的AR临床症状前3d就已经开始升高,经过有效的抗排斥治疗后,表达明显减弱或转阴。结论监测外周血淋巴细胞中穿孔素和颗粒酶B的表达水平,可做为早期发现AR的一种检测方法。穿孔素和颗粒酶B可以反映急性排斥的病情,对移植肾的预后有一定的指导价值。更多还原

【Abstract】 Objective To study the mechanism of acute rejection of human renal transplantation and detect the sensitive markers for early diagnosis of acute rejection. Methods Immunohistochemistry was used to detect the expression of Perforin and Granzyme B molecules during acute rejection in the renal grafts. The immunocytochemical ABC assay and flow cytometry ways were used to detect the expression of Perforin and Granzyme B molecules in peripheral blood. Results Perforin and Granzyme B molecules were increased in all tissue specimens and lymphocytes of peripheral blood during acute rejection. There was a correlation between the Granzyme B and histological changes ( P < 0.01 ). Granzyme B was increased about 3 days earlier than the appearance of symptoms, and intensive therapy of acute episodes decreased the expression of two markers. Conclusion Perforin and Granzyme B are useful for monitoring the clinical acute rejection, and they are valuable for diagnosis of earlier acute rejection.更多还原