Carrier M, Russell D H, Cork R C, Wild J, Emery R W, Copeland J G
Department of Cardiovascular Surgery, University of Arizona, Tucson.
J Heart Transplant. 1990 Jul-Aug;9(4):372-5.
The diagnosis of cardiac allograft rejection is currently based on endomyocardial biopsy and histologic evaluation. Since the introduction of cyclosporine, cardiac biopsy has been recognized as the only reliable method of diagnosis. From July 1985 to June 1986, 22 transplant patients were studied during the early posttransplant period to evaluate other characteristics of allograft rejection. The immunosuppressive protocol included cyclosporine, azathioprine, prednisone, and prophylactic rabbit antithymocyte globulin. Acute rejection was established by standard histologic criteria. Twenty-four positive and 123 negative biopsy findings were obtained. Clinical variables (age, sex, immunosuppressive regimen, cyclosporine dosage, ECG voltage), biologic variables (level of cyclosporine, white blood cells, blood urea nitrogen, creatinine, bilirubin, prolactin, urinary polyamines, blood type, HLA typing), and immunologic variables (T-cell subsets) were analyzed in regard to the histologic diagnosis of acute rejection. Four variables (WBC, prolactin, total urinary polyamines, N-acetyl putrescine) were found to have a significant univariate association with acute rejection. These variables were studied by multivariate discriminant analysis. The only factors found to have independent predictive value for acute rejection were prolactin and N-acetyl putrescine peaks occurring before acute rejection. When we used these factors, a discriminant function correctly predicted acute rejection episodes, as well as negative biopsy results, in 74% of the cases in this group of patients.
目前，心脏移植排斥反应的诊断基于心内膜心肌活检和组织学评估。自环孢素问世以来，心脏活检一直被视为唯一可靠的诊断方法。1985年7月至1986年6月，对22例移植患者在移植后的早期进行了研究，以评估移植排斥反应的其他特征。免疫抑制方案包括环孢素、硫唑嘌呤、泼尼松和预防性兔抗胸腺细胞球蛋白。急性排斥反应根据标准组织学标准确定。获得了24例阳性和123例阴性活检结果。针对急性排斥反应的组织学诊断，分析了临床变量（年龄、性别、免疫抑制方案、环孢素剂量、心电图电压）、生物学变量（环孢素水平、白细胞、血尿素氮、肌酐、胆红素、催乳素、尿多胺、血型、HLA分型）和免疫学变量（T细胞亚群）。发现四个变量（白细胞、催乳素、总尿多胺、N - 乙酰腐胺）与急性排斥反应存在显著的单变量关联。通过多变量判别分析对这些变量进行了研究。发现对急性排斥反应具有独立预测价值的唯一因素是急性排斥反应之前出现的催乳素和N - 乙酰腐胺峰值。当我们使用这些因素时，判别函数在该组患者中74%的病例中正确预测了急性排斥反应发作以及阴性活检结果。
