目的 检测活体肾移植受者外周血调节性T细胞(Treg)和辅助性T淋巴细胞17(Th17)的比例,探寻肾移植术后外周血Treg细胞、Th17细胞及Th17/Treg比值的动态变化规律.方法 采用前瞻性研究方法,用流式细胞术分别检测活体肾移植受者术前和术后1、2、3周及术后1、2、3、4、5、6个月的外周血Treg细胞、Th17细胞比例.结果 Treg细胞比例在术后第2周明显下降(P＜0.05),术后2个月降至最低,较术前相比下降68.6％ (P ＜0.05),术后6个月恢复至术前水平.Th17细胞比例在术后1周至3周明显升高(P＜0.05),术后1个月恢复至术前水平.移植后第1周Th 17/Treg细胞比值明显升高(P＜0.05),持续至术后3个月,术后6个月恢复至术前水平.术后使用环孢素的受者Treg细胞比例在术后2个月最低,下降67.1％ (P ＜0.05);术后使用他克莫司的受者Treg细胞比例在术后3周最低,下降80.8％(P ＜0.05),均在术后3个月开始缓慢上升.CD3+T细胞比例在术后1周降低(P＜0.05),术后3周恢复至术前水平.结论 活体肾移植术后免疫细胞处于动态变化.术后2周到5个月Treg细胞比例均明显降低,其中以术后2个月最低.Th17/Treg细胞比值在术后1周到3个月均明显升高.他克莫司和环孢素对肾移植术后Treg细胞都有抑制作用.%Objective To detect the expression percentages of regulatory T cell(Treg) and T helper 17 cell(Th17) in peripheral blood of living donor renal transplant recipients(RTRs) and to investigate the dynamic change pattern of Treg cell,Th17 cell and Th17/Treg ratio after living donor renal transplantation.Methods The study was prospective.The expression percentages of Treg cell and Th17 cell were determined with flow cytometry before transplantation and 1,2,3 weeks as well as 1,2,3,4,5,6 months after transplantation in living donor RTRs.Results ① The percentage of Treg cell decreased significantly in two weeks after transplantation in RTRs (P ＜ 0.05).The lowest-proportion of Treg occurred in 2nd month after transplantation,which decreased by 68.6％ compared with pretransplantation status(P ＜0.05).Proportion of Treg cell gradually gained back to baseline in 6th month post-transplantation.The percentage of Th17 cell within 3 weeks post-transplantation significantly increased compared with the pre-transplantation status(P ＜0.05),and dropped to baseline in one month post-transplantation.The significantly increased ratio of Th17/Treg observed one week post-transplantation last for nearly 3 months(P ＜ 0.05) and returned to baseline in 6th month.② The ratio of Treg in cyclosporine-a treatment RTRs demonstrated the lowest level in 2nd month post-transplantation,which decreased by 67.1％ compared with baseline(P ＜ 0.05).However,the lowest ratio of Treg in tacrolimus-treated group which decreased by 80.8％ compared with the baseline occurred in the 3 rd week (P ＜ 0.05).Both groups demonstrated a gradual recovery of Treg ratio three months post transplantation.③ The proportion of CD3 + T cell dropped to the lowest level within 1 week after transplantation (P ＜ 0.05),and rapidly rose to the baseline at the 3rd week.Conclusion Immune cell ratio is in a fluctuating status after living donor kidney transplantation.The proportion of Treg cell significantly decreases from 2nd week to 5th month after operation,with the lowest level in 2nd month.The ratio of Th17/Treg significantly increases from 1st week to 3rd month after operation.Both tacrolimus and cyclosporine have inhibitory effects on Treg cell post-transplantation.
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