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目的:肾移植患者由于术前透析及术后服用免疫抑制剂,显著增加了人巨细胞病毒(Human cytomegalovirus,HCMV)原发感染和潜伏感染被激活的机会。观察HCMV感染情况与血T淋巴细胞亚群及肾功能的变化,以探讨其相关性及临床意义。方法:跟踪收集40例肾移植患者术前、术后血标本,应用RT-PCR技术检测HCMV,流式细胞术检测淋巴细胞亚群,结合肾功能判断是否发生急性排斥或移植肾功能恢复延迟。结果:肾移植术后HCMV感染率为52.5%,10例出现症状性感染(25%),出现阳性时间35.7±15.3天。症状性感染组CD3+、CD4+的水平和CD4+/CD8+的比值较无活动性感染组和正常对照组均降低,CD8+水平较其他组升高,差异有显著性意义(P<0.05)。无症状性活动感染者与无活动性感染者各指标比较差异无显著性。活动性感染组急性排斥或移植肾功能恢复延迟发生8例(38.1%),无活动性感染组发生1例(5.2%),差异具有统计学意义(x2=6.15,P<0.05)。结论:肾移植术后HCMV感染能显著引起T淋巴细胞亚群变化,尤其是CD4+/CD8+。并与急性排斥或移植肾功能恢复延迟密切相关联,在其发生发展中可能起着重要的作用。三者相互联系、相互作用、互为因果,对进一步机制的研究及临床诊断治疗、预后方面有一定意义。
OBJECTIVE: In renal transplant patients, preoperative dialysis and postoperative immunosuppressive agents significantly increase the chances of primary and latent infection of human cytomegalovirus (HCMV) being activated. To observe the changes of HCMV infection, blood T lymphocyte subsets and renal function in order to investigate its correlation and clinical significance. Methods: Preoperative and postoperative blood samples were collected from 40 renal transplant recipients. HCMV was detected by RT-PCR. Flow cytometry was used to detect lymphocyte subsets. Renal function was used to determine whether there was acute rejection or delayed graft function recovery. Results: The infection rate of HCMV after renal transplantation was 52.5%. Symptomatic infection occurred in 10 cases (25%) and the positive time was 35.7 ± 15.3 days. The ratio of CD3 +, CD4 + and CD4 + / CD8 + in patients with symptomatic infection was significantly lower than that in patients without active infection and normal controls, and the level of CD8 + was higher than other groups (P <0.05). There was no significant difference between the indicators of asymptomatic active infection and those without active infection. There were 8 cases (38.1%) of patients with active infection or delayed graft recovery, and 1 case (5.2%) of patients without active infection. The difference was statistically significant (x2 = 6.15, P <0.05). CONCLUSION: HCMV infection can significantly change the T lymphocyte subsets, especially CD4 + / CD8 +, after renal transplantation. And is closely related to the delay of recovery from acute rejection or graft function and may play an important role in its development. The three are interrelated and interact with each other and cause and effect each other, which has some significance to the further mechanism research, clinical diagnosis and treatment and prognosis.