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目的 通过对肾移植患者急性排斥反应时尿中出现的供体细胞的DNA进行检测 ,试图找到一种方便快速、无创性诊断肾移植急性排斥反应的新方法。方法 以供体为男性 ,受体为女性或HLA -DR抗原有错配的肾移植患者 80例为研究对象 ,其中急性排斥反应 34例 ,肾功能正常者 4 1例 ,药物性肾功能损伤 5例。利用PCR及PCR -SSP法分别检测Y染色体上特异的基因片断SRY、DYZ - 1和HLA -DR抗原的基因片断DRBl。结果 供体为男性的女性急性排斥反应患者 11例 ,SRY阳性 10例 (90 .9% ) ,DYZ - 1阳性 11例(10 0 % ) ;对照组肾功能正常患者 14例 ,SRY的检测结果为阳性 1例 ,阴性 13例 (92 .8% ) ;DYZ - 1阳性 2例 ,阴性 12例 (85 .7% )。HLA -DR抗原有错配的急性排斥反应 2 3例 ,DRBl阳性 2 1例 (91.3% ) ,阴性 2例 ,经抗排斥治疗 17例转为阴性 ;对照组肾功能正常患者 2 7例 ,DRBI阳性 3例 ,阴性 2 4例 (88.9% )。药物性肾功能损伤 5例的PCR检测结果均为阴性。结论 肾移植术后急性排斥反应发生时 ,患者尿中来自供体细胞的DNA高频率地出现 ,随着抗排斥治疗移植肾功能恢复而消失。同时 ,肾功能正常及药物性肾功能损伤患者供体细胞的DNA检测为阴性 ,说明肾移植患者尿中供体细胞DNA的PCR检测可以作为诊断急性排斥反应并与药物性
OBJECTIVE: To find out a new method to diagnose acute rejection in renal transplantation by detecting the DNA of donor cells in urine during acute rejection of renal allograft. Methods Eighty renal transplant recipients with male donor and female recipient or HLA-DR antigen mismatch were studied. Among them, 34 were acute rejection, 41 were with normal renal function, 5 were renal injury example. The specific gene fragment SRY, DYZ - 1 and HLA - DR antigen gene fragment DRB1 were detected by PCR and PCR - SSP. Results Eleven patients were male with acute rejection, 10 (90.9%) positive for SRY and 11 positive for DYZ - 1 (10 0%). The control group had 14 patients with normal renal function and the results of SRY 1 case was positive and 13 cases were negative (92.8%). DYZ - 1 was positive in 2 cases and negative in 12 cases (85.7%). 23 cases of HLA-DR antigen mismatch acute rejection, 21 cases of DRB1 positive (91.3%), negative in 2 cases, anti-rejection treatment 17 cases turned negative; control group of normal renal function in 27 cases, DRBI 3 were positive and 24 were negative (88.9%). 5 cases of drug-induced renal injury by PCR test results were negative. Conclusions When acute rejection occurs after kidney transplantation, the DNA from donor cells in the urine of patients appears at high frequency and disappears with the recovery of graft function after anti-rejection treatment. At the same time, DNA tests of donor cells in patients with normal renal function and drug-induced renal impairment were negative, indicating that PCR detection of urine donor cells DNA in renal transplant patients can be used as a diagnostic tool for acute rejection and drug resistance