Ruggeri Z M, Gordon Y B, Ardaillou N, Larrieu M J, Tarantino A, Coppola R, Ponticelli C, Mannucci P M
Br Med J. 1979 Feb 3;1(6159):300-3. doi: 10.1136/bmj.1.6159.300.
The urinary excretion of factor-VIII-related antigen (VIIIRAg) was measured in 72 patients with kidney transplants and compared with that of two end-products of fibrin-fibrinogen lysis (fragments D and E) to assess their usefulness in monitoring the onset of rejection episodes. Specific and sensitive radioimmunoassays were used to measure the three proteins. Unconcentrated urine samples of 24-hour collections were obtained from 20 healthy subjects, 48 patients with stable transplants, and 24 patients with recent transplants serially followed up from the day of transplantation. Factor VIIIRAg and fragments E and D were not detectable in the urine from healthy subjects but were present in 39%, 60%, and 100% respectively of samples from patients with stable transplants. During 33 acute rejection episodes in 19 patients with recent transplants factor VIIIRAg and fragments E and D were significantly increased above the values observed in patients with stable transplants in 82%, 73%, and 64% of samples respectively; in patients with recent transplants showing no clinical sign of rejection increased excretion of these proteins was observed in 11%, 26%, and 22% of samples respectively. The presence of factor VIIIRAg in urine from patients with kidney allografts suggests that endothelial cell-factor VIII-platelet interactions might pay a key part in the pathogenesis of acute rejection. The results suggest that the assay of factor VIIIRAg in urine is more useful than assays of fragments D and E as a corroborative index of transplant rejection.
对72例肾移植患者的凝血因子VIII相关抗原（VIIIRAg）尿排泄量进行了测定，并与纤维蛋白 - 纤维蛋白原溶解的两种终产物（D片段和E片段）进行比较，以评估它们在监测排斥反应发作中的作用。采用特异性和灵敏的放射免疫分析法测定这三种蛋白质。从20名健康受试者、48例移植稳定的患者以及24例近期移植患者（自移植日起连续随访）中获取24小时未浓缩的尿液样本。健康受试者尿液中未检测到VIIIRAg以及E片段和D片段，但在移植稳定患者的样本中，分别有39%、60%和100%的样本中存在这些物质。在19例近期移植患者的33次急性排斥反应发作期间，VIIIRAg以及E片段和D片段在样本中的含量分别在82%、73%和64%的情况下显著高于移植稳定患者；在近期移植但无排斥反应临床体征的患者中，分别有11%、26%和22%的样本中观察到这些蛋白质排泄增加。同种异体肾移植患者尿液中存在VIIIRAg表明内皮细胞 - 凝血因子VIII - 血小板相互作用可能在急性排斥反应的发病机制中起关键作用。结果表明，作为移植排斥反应的佐证指标，尿中VIIIRAg的检测比D片段和E片段的检测更有用。
