Wijngaard P L, Doornewaard H, van der Meulen A, Plomp S, Gmelig Meyling F H, de Jonge N, Schuurman H J
Department of Immunology, Heart Transplantation Centre Utrecht/Groningen.
J Heart Lung Transplant. 1994 Sep-Oct;13(5):869-75.
The cytoimmunologic monitoring assay has been proposed as a useful noninvasive technique in the diagnosis of rejection and infection after heart transplantation. In this study, we have analyzed the diagnostic usefulness of cytoimmunologic monitoring in 73 patients after heart transplantation. For individual patients, the follow-up varied between 2 and 78 months. Data were related to histopathologic characteristics of the endomyocardial biopsy. Significantly different cytoimmunologic monitoring results were not observed between groups according to endomyocardial biopsy histopathologic evaluation. The diagnostic usefulness of cytoimmunologic monitoring depended on the cutoff value applied. With higher cutoff values, the sensitivity decreased and the specificity and predictive value increased. For the previously reported cutoff value of 5%, the sensitivity was 0.29, the specificity was 0.73, and the predictive value was 0.66. Values of sensitivity, specificity, and predictive value were similar when only the first acute rejection was taken into account, or when only data on the first 4 weeks and the first 6 months after transplantation were considered. In calculating the diagnostic usefulness of the sensitivity, specificity, and predictive values were observed. We concluded that cytoimmunologic monitoring has a limited value for diagnosing acute rejection after heart transplantation.
细胞免疫监测测定法已被提议作为心脏移植后排斥反应和感染诊断中的一种有用的非侵入性技术。在本研究中，我们分析了细胞免疫监测在73例心脏移植患者中的诊断效用。对于个体患者，随访时间在2至78个月之间。数据与心内膜心肌活检的组织病理学特征相关。根据心内膜心肌活检组织病理学评估，各亚组之间未观察到明显不同的细胞免疫监测结果。细胞免疫监测的诊断效用取决于所应用的临界值。临界值越高，敏感性降低，特异性和预测值增加。对于先前报道的5%的临界值，敏感性为0.29，特异性为0.73，预测值为0.66。仅考虑首次急性排斥反应时，或仅考虑移植后前4周和前6个月的数据时，敏感性、特异性和预测值相似。在计算诊断效用时观察到了敏感性、特异性和预测值。我们得出结论，细胞免疫监测在诊断心脏移植后急性排斥反应方面价值有限。
