Ben-Youssef Ramzi, Baron Pedro W, Sahney Shobha, Weissman Jill, Baqai Waheed, Franco Edson, Kore Arputharaj, Trimzi Mateen, Ojogho Okechukwu
Transplantation Institute, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Pediatr Transplant. 2009 Nov;13(7):851-5. doi: 10.1111/j.1399-3046.2008.01073.x. Epub 2008 Oct 31.
ImmuKnow measures ATP (ng/mL) in PHA-activated CD4+ T cells from patient's whole blood. According to published reports, median ImmuKnow is 258 ng/mL in stable pediatric kidney transplant (PKT) recipients > or =12 yr, and 165 ng/mL in those <12 yr. However, data on the effect of infection or AR on ImmuKnow are scarce. We studied the effect of Epstein-Barr virus (EBV) viremia on ImmuKnow in PKT with GD. Twenty-eight PKT with GD were reviewed. Group 1 has 19 PKT > or =12 yr, and group 2 has nine PKT <12 yr. Mean follow-up was 19.4 +/- 12 months. All ImmuKnow values discussed in this study were measured during GD +/- fever. None had ImmuKnow pretransplant. EBV DNA was isolated from patient blood by real-time PCR. Group 1 has eight boys and 11 girls (mean age = 16.6 +/- 2.4 yr). Group 2 has two boys and seven girls (mean age = 6 +/- 3.1 yr). Median ImmuKnow was 292 ng/mL in group 1, and 370 ng/mL in group 2. Nine children developed EBV viremia: two in group 1 (median ImmuKnow = 273 ng/mL), and seven in group 2 (median ImmuKnow = 475 ng/mL). Overall mean ImmuKnow in the nine EBV viremic patients was higher than that in the 19 non-viremic ones (422 +/- 176 ng/mL, and 302 +/- 113 ng/mL, respectively, unequal variance t-test, p = 0.08). Eight children developed AR (all in G1, median ImmuKnow = 272 ng/mL). In group 1, one patient developed concurrent EBV viremia and rejection, while another patient developed EBV viremia six months following a rejection episode. In group 2, none developed simultaneous AR, CMV, or BK virus infection with EBV viremia. None developed post-transplant lymphoproliferative disease. In summary, EBV viremia was paradoxically associated with high ImmuKnow in PKT <12 yr. This suggests strong co-stimulation of PHA-activated CD4+ T cells by EBV-transformed B cells.
免疫功能检测（ImmuKnow）可测定患者全血中经植物血凝素（PHA）激活的CD4+T细胞中的三磷酸腺苷（ATP，纳克/毫升）水平。根据已发表的报告，年龄≥12岁的稳定期小儿肾移植（PKT）受者的免疫功能检测中位数为258纳克/毫升，而年龄<12岁者为165纳克/毫升。然而，关于感染或急性排斥反应（AR）对免疫功能检测影响的数据却很少。我们研究了爱泼斯坦-巴尔病毒（EBV）血症对患有肾小球疾病（GD）的PKT患者免疫功能检测的影响。回顾性分析了28例患有GD的PKT患者。第1组有19例年龄≥12岁的PKT患者，第2组有9例年龄<12岁的PKT患者。平均随访时间为19.4±12个月。本研究中讨论的所有免疫功能检测值均在GD±发热期间测得。所有患者移植前均未检测免疫功能检测值。通过实时聚合酶链反应（PCR）从患者血液中分离出EBV DNA。第1组有8名男孩和11名女孩（平均年龄=16.6±2.4岁）。第2组有2名男孩和7名女孩（平均年龄=6±3.1岁）。第1组的免疫功能检测中位数为292纳克/毫升，第2组为370纳克/毫升。9名儿童发生了EBV血症：第1组2例（免疫功能检测中位数=273纳克/毫升），第2组7例（免疫功能检测中位数=475纳克/毫升）。9例发生EBV血症患者的总体平均免疫功能检测值高于19例未发生血症患者（分别为422±176纳克/毫升和302±113纳克/毫升，方差不齐t检验，p=0.08）。8名儿童发生了AR（均在第1组，免疫功能检测中位数=272纳克/毫升）。在第1组中，1例患者同时发生了EBV血症和排斥反应，另1例患者在排斥反应发作6个月后发生了EBV血症。在第2组中，没有患者同时发生AR、巨细胞病毒（CMV）或BK病毒感染与EBV血症。没有患者发生移植后淋巴细胞增生性疾病。总之，在年龄<12岁的PKT患者中，EBV血症与高免疫功能检测值呈矛盾相关。这表明EBV转化的B细胞对PHA激活的CD4+T细胞有强烈的共刺激作用。
