Mooney M L, Carlson P, Szentpetery S, Duma R J, Markowitz S M
Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0049.
Transplantation. 1990 Dec;50(6):951-4. doi: 10.1097/00007890-199012000-00010.
Monitoring peripheral lymphocytes for changes in antigen expression or subpopulations was performed by flow cytometry in an attempt to identify infection or rejection in cardiac transplantation recipients (CTRs). In this study, 32 cardiac transplantation recipients were followed prospectively, and the results of 274 lymphocyte analyses for transferrin receptor expression, an indicator of lymphocyte activation, and CD4/CD8 lymphocyte ratios were correlated with the patient's clinical status, e.g., infection (early or late), rejection (mild, moderate, or severe), or quiescence. The percentage of lymphocytes expressing the transferrin receptor (%TR+) increased significantly during all stages of infection (2.9%, P = 0.02), or stratified into early (2.7%, P = 0.03) or late stage infection (2.6%, P = 0.03). The increase in %TR+ lymphocytes was also noted during mild (2.8%, P = 0.01) and moderate (3.0%, P = 0.008) rejection. The specificity and positive predictive value of an increased %TR+ lymphocyte was 97% and 93%, respectively, during early infection; 92 and 71%, respectively, during mild rejection; and 85 and 80%, respectively, during moderate rejection. The CD4/CD8 lymphocyte ratio did not correlate with either infection or rejection (P greater than 0.05). In conclusion, an increase in the %TR+ lymphocytes indicates the presence of infection, especially acute infection, or, less likely, rejection in the cardiac transplant recipient, but its clinical utility may be as a screening test for the presence of infection, especially early infection in CTRs during the posttransplantation period. The CD4/CD8 lymphocyte ratio does not correlate with the presence of infection or rejection in the CTR.
通过流式细胞术监测外周淋巴细胞抗原表达或亚群的变化，以试图识别心脏移植受者（CTR）中的感染或排斥反应。在本研究中，对32名心脏移植受者进行了前瞻性随访，274次淋巴细胞分析中关于转铁蛋白受体表达（淋巴细胞活化的指标）及CD4/CD8淋巴细胞比值的结果与患者的临床状态相关，例如感染（早期或晚期）、排斥反应（轻度、中度或重度）或静止期。在感染的所有阶段，表达转铁蛋白受体的淋巴细胞百分比（%TR+）均显著增加（2.9%，P = 0.02），若分层为早期感染（2.7%，P = 0.03）或晚期感染（2.6%，P = 0.03）也是如此。在轻度（2.8%，P = 0.01）和中度（3.0%，P = 0.008）排斥反应期间也观察到%TR+淋巴细胞增加。在早期感染期间，%TR+淋巴细胞增加的特异性和阳性预测值分别为97%和93%；在轻度排斥反应期间分别为92%和71%；在中度排斥反应期间分别为85%和80%。CD4/CD8淋巴细胞比值与感染或排斥反应均无相关性（P大于0.05）。总之，%TR+淋巴细胞增加表明心脏移植受者存在感染，尤其是急性感染，或较少可能存在排斥反应，但其临床效用可能是作为感染存在的筛查试验，尤其是移植后时期CTR中的早期感染。CD4/CD8淋巴细胞比值与CTR中感染或排斥反应的存在无关。
