Mazaheri R, Stiller C R, Keown P A
Diagn Immunol. 1986;4(5):257-67.
Absolute levels of peripheral blood mononuclear cells were sequentially monitored by immunocytometry in 54 consecutive renal allograft recipients receiving azathioprine/prednisone (STD gp, N = 16) or cyclosporine with or without prednisone (CsA gp, N = 38), before and after transplantation. In the CsA group, but not in those receiving STD therapy, the mean absolute levels of all but OKT4+ cells increased significantly with the duration of therapy. In both treatment groups (STD + CsA), the mean % delta OKT4/8 ratio increased from a prerejection quiescent value of 80 +/- 6% SE to a rejection value of 120 +/- 6% (P less than .001) and fell back to 77 +/- 6% (P less than .0005) in postrejection quiescence. The sensitivity and specificity of such an elevated ratio for rejection were 84.4% and 88.6%, while positive and negative likelihood ratios were 7.40 and 0.15, respectively. In rejection, concomitant immunopathology showed a predominance of OKT8+ cells in the graft with a mean T cell subset ratio of 0.8 +/- 0.3 SE in renal biopsies compared to 2.0 +/- 0.3 for circulating cells (P less than .0125). Parallel donor-antigen-specific assay of lymphocyte-mediated cytotoxicity (LMC) became positive with graft rejection. Immunocytometry with normalization of sequential data in longitudinal analysis thus appears to be a valuable tool in immunologic laboratory monitoring of graft rejection.
采用免疫细胞计数法，对54例接受硫唑嘌呤/泼尼松（标准治疗组，N = 16）或环孢素（联合或不联合泼尼松）（环孢素组，N = 38）治疗的连续肾移植受者在移植前后外周血单核细胞的绝对水平进行了连续监测。在环孢素组中，除OKT4 +细胞外，所有细胞的平均绝对水平均随治疗时间显著升高，而接受标准治疗的患者则未出现这种情况。在两个治疗组（标准治疗组 + 环孢素组）中，平均OKT4/8比值百分比从排斥反应前的静止值80±6%标准误升高到排斥反应时的120±6%（P <.001），排斥反应后静止期又降至77±6%（P <.0005）。这种升高的比值对排斥反应的敏感性和特异性分别为84.4%和88.6%，阳性和阴性似然比分别为7.40和0.15。在排斥反应中，免疫病理学检查显示移植物中OKT8 +细胞占优势，肾活检中T细胞亚群平均比值为0.8±0.3标准误，而循环细胞为2.0±0.3（P <.0125）。随着移植物排斥反应的发生，淋巴细胞介导的细胞毒性（LMC）的平行供体抗原特异性检测呈阳性。因此，在纵向分析中对连续数据进行标准化的免疫细胞计数法似乎是移植排斥反应免疫实验室监测中的一种有价值的工具。
