Ross D J, Yeh A Y, Nathan S D, Toyoda M, Galera O, Marchevsky A, Kass R M, Koerner S K, Jordan S C
Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.
J Heart Lung Transplant. 1994 Nov-Dec;13(6):972-9.
Preliminary reports suggest that measurement of the soluble 55 kd subunit of the interleukin-2 receptor may facilitate the diagnosis of allograft rejection in solid organ transplants. Levels of soluble interleukin-2 receptor in serum or plasma have previously lacked sufficient sensitivity and specificity for the diagnosis of acute allograft rejection. Because single lung transplantation is preferentially performed for nonseptic end-stage pulmonary and cardiopulmonary maladies, we questioned whether the pattern of soluble interleukin-2 receptor recovery in bronchoalveolar lavage fluid obtained from both the native and transplanted lungs may enhance correct diagnosis. Fifty-three consecutive fiberoptic bronchoscopic procedures were performed with bilateral bronchoalveolar lavage fluid. Transbronchoscopic biopsies were histologically classified by the International Society for Heart Transplantation Working Formulation for Standardized Nomenclature. "Soluble interleukin-2 receptor index" was calculated as the quotient of soluble interleukin-2 receptor (in units per milliliter) by enzyme-linked immunosorbent assay, divided by protein (in milligrams per milliliter) to correct for differences in bronchoalveolar lavage fluid techniques and cellularity. Soluble interleukin-2 receptor indexes were significantly increased in the allograft bronchoalveolar lavage fluid during histologic grade A (acute rejection) versus normal transbronchoscopic biopsy specimens (3395 +/- 1298 U/mg versus 76 +/- 21 U/mg) associated with an increased transplanted/native lung ratio (69.9 +/- 46 versus 2 +/- 1 [mean +/- standard error of the mean]) (one-way analysis of variance, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
初步报告表明，检测白细胞介素-2受体的可溶性55kd亚基可能有助于实体器官移植中同种异体移植排斥反应的诊断。血清或血浆中可溶性白细胞介素-2受体的水平此前在诊断急性同种异体移植排斥反应方面缺乏足够的敏感性和特异性。由于单肺移植优先用于非感染性终末期肺部和心肺疾病，我们质疑从天然肺和移植肺获取的支气管肺泡灌洗液中可溶性白细胞介素-2受体的恢复模式是否能提高正确诊断率。对53例连续的纤维支气管镜检查进行双侧支气管肺泡灌洗。经支气管活检按照国际心脏移植学会标准化命名工作公式进行组织学分类。“可溶性白细胞介素-2受体指数”通过酶联免疫吸附测定法计算，即可溶性白细胞介素-2受体（单位为每毫升）除以蛋白质（单位为每毫克），以校正支气管肺泡灌洗技术和细胞数量的差异。在组织学A级（急性排斥反应）时，同种异体移植支气管肺泡灌洗液中的可溶性白细胞介素-2受体指数显著高于正常经支气管活检标本（3395±1298U/mg对76±21U/mg），同时移植肺/天然肺比值增加（69.9±46对2±1[平均值±平均标准误]）（单因素方差分析，p<0.01）。（摘要截短至250字）
