【摘要】 探讨外周血淋巴细胞(peripheral blood lymphocyte,PBL)穿孔素和颗粒酶B mRNA检测对肾移植急性排斥反应(AR)的早期诊断价值。采用RT-PCR方法动态检测67例肾移植AR患者外周血淋巴细胞穿孔素和颗粒酶B mRNA的表达水平,同时检测所有患者肌酐(Cr)表达水平情况,比较各时间点穿孔素、颗粒酶B mRNA及Cr表达水平,并探讨穿孔素、颗粒酶B与AR的关系。移植后1d与移植前1d比较,PBL穿孔素、颗粒酶B mRNA表达水平比较无明显差异性(P>0.05),Cr表达水平明显下降(P<0.05);AR前3d较之前各时间点比较,PBL穿孔素、颗粒酶B mRNA表达水平明显上升(P<0.05),而Cr表达水平明显下降(P<0.05);AR后1d时PBL穿孔素、颗粒酶B mRNA表达水平达到最高峰,随后逐渐下降(P<0.05),而AR后5d时Cr表达水平达到最高峰,随后逐渐下降(P<0.05);PBL穿孔素、颗粒酶B mRNA表达水平升高时间比Cr早4d,AR患者经MP/OKT3冲击治疗后,PBL穿孔素和颗粒酶B mRNA表达水平逐渐降低至原有基础水平。PBL穿孔素和颗粒酶B mRNA在AR早期诊断和抗排斥反应疗效评估等方面具有一定的临床价值。更多还原

【Abstract】 To investigate the early diagnostic value of perforin and granzyme B mRNA of peripheral blood lymphocytes(PBL) in detection of renal allograft acute rejection(AR),perforin and granzyme B mRNAs expression of PBL in 67 patients with renal allograft AR were dynamically measured by quantitative reverse transcription PCR(RT-PCR).At the same time,the creatinine(Cr) was examined in all patients.The levels of mRNA of perforin and granzyme B as well of Cr value at different time points were compared,and the relationship of perforin,granzyme B and AR was analyzed.When the levels of the 3 indeces on day 1 after transplantation was compared with those on day 1 after transplantation,mRNA of perforin and granzyme B remained unchanged(P>0.05) whereas the value of Cr decreased significantly(P<0.05).Three days prior to AR took place,mRNA levels of perforin and granzyme B were increased significantly(P<0.05) compared with those of all previous time points,and while the level of Cr was decreased significantly(P<0.05).The levels of mRNA of PBL perforin and granzyme B reached the peak 1d after AR,then decreased gradually(P<0.05),but the level of Cr reached the peak 5 days after AR,then decreased gradually(P<0.05).Therefore the increase of perforin and granzyme B mRNA appeared 4 days earlier than Cr.The levels of perforin and granzyme B mRNA decreased to the original basic levels by MP/OKT3 pulse therapy.These results showed that the levels of perforin and granzyme B mRNA of PBL may be a noninvasive,sensitive indices for early diagnosis of AR and for assessing clinic effect of anti-rejection therapy,and It may be worthy of clinical application.更多还原