免疫细胞功能检测对肺移植受者非巨细胞病毒感染的预测价值：一项多中心前瞻性观察研究。

Predictive Value of Immune Cell Functional Assay for Non-Cytomegalovirus Infection in Lung Transplant Recipients: A Multicenter Prospective Observational Study.

机构信息

Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain.

出版信息

Arch Bronconeumol. 2021 Nov;57(11):690-696. doi: 10.1016/j.arbr.2020.12.012.

DOI:10.1016/j.arbr.2020.12.012

PMID:35699006

Abstract

INTRODUCTION

Immune cell functional assay (ImmuKnow®) is a non-invasive method that measures the state of cellular immunity in immunosuppressed patients. We studied the prognostic value of the assay for predicting non-cytomegalovirus (CMV) infections in lung transplant recipients.

METHODS

A multicenter prospective observational study of 92 patients followed up from 6 to 12 months after transplantation was performed. Immune cell functional assay was carried out at 6, 8, 10, and 12 months.

RESULTS

Twenty-three patients (25%) developed 29 non-CMV infections between 6 and 12 months post-transplant. At 6 months, the immune response was moderate (ATP 225-525ng/mL) in 14 (15.2%) patients and low (ATP<225ng/mL) in 78 (84.8%); no patients had a strong response (ATP≥525ng/mL). Only 1 of 14 (7.1%) patients with a moderate response developed non-CMV infection in the following 6 months compared with 22 of 78 (28.2%) patients with low response, indicating sensitivity of 95.7%, specificity of 18.8%, positive predictive value (PPV) of 28.2%, and negative predictive value (NPV) of 92.9% (AUC 0.64; p=0.043). Similar acute rejection rates were recorded in patients with mean ATP≥225 vs. <225ng/mL during the study period (7.1% vs. 9.1%, p=0.81).

CONCLUSION

Although ImmuKnow® does not seem useful to predict non-CMV infection, it could identify patients with a very low risk and help us define a target for an optimal immunosuppression.

摘要

简介

免疫细胞功能检测（ImmuKnow®）是一种非侵入性方法，可测量免疫抑制患者的细胞免疫状态。我们研究了该检测对预测肺移植受者非巨细胞病毒（CMV）感染的预后价值。

方法

对 92 例患者进行了一项多中心前瞻性观察研究，这些患者在移植后 6 至 12 个月进行了随访。在 6、8、10 和 12 个月时进行了免疫细胞功能检测。

结果

在移植后 6 至 12 个月期间，23 例（25%）患者发生 29 例非 CMV 感染。在 6 个月时，14 例（15.2%）患者的免疫反应为中度（ATP 225-525ng/mL），78 例（84.8%）患者的免疫反应为低度（ATP<225ng/mL）；没有患者表现出强烈反应（ATP≥525ng/mL）。在接下来的 6 个月中，仅有 1 例（7.1%）中度反应患者发生非 CMV 感染，而低度反应患者中则有 22 例（28.2%）发生，表明敏感性为 95.7%，特异性为 18.8%，阳性预测值（PPV）为 28.2%，阴性预测值（NPV）为 92.9%（AUC 0.64；p=0.043）。在研究期间，平均 ATP≥225ng/mL 与<225ng/mL 的患者记录到相似的急性排斥反应率（7.1%比 9.1%，p=0.81）。