同种异体手移植患者术后黏附分子的动态变化及意义

摘要

AIM: To explore the dynamic changes of adhesion molecules of patients following the treatment with human hand allograft and the clinical significance of the changes.METHODS: Peripheral blood samples were obtained from three patients treated with hand allograft at preoperation and from 1 day to 180 days after operation to investigate the dynamic expressions of adhesion molecules with flow cytometry (FCM).RESULTS: Levels of CD4, CD8, CD28, CD54 and CD11a declined from the first day and to the lowest point on the sixth day after operation. Then,they began to increase gradually from the 7th day to the 180th day, amongst which, levels of CD4, CD28 and CD54 were consistently lower than those of pre-operation; in contrast, CD1 1a resumed to the pre-transplantation level on the 20th day and CD8 steadily increased to obviously a higher level compared with that of pre-operation on the 30th day after operation. ( t =4.1, P ＜0.05).CONCLUSION: Immuosuppressants obviously inhibited the expressions of adhesion molecules. No obvious rejections were found in patients receiving hand allogarft according to clinical observations, indicating that adhesion molecules could be considered as a monitoring index for acute rejections,which is of great importance in improving not only the survival rate of hand allograft, but also long-term functional recovery.%目的:探讨同种异体手移植患者术后外周血黏附分子的动态变化及意义.方法:用流式细胞仪对3例同种异体手移植术前患者和术后1～180 d外周血黏附分子水平进行动态观察.结果:患者外周血黏附分子CD4,CD8,CD28,CD54,CD11 a的水平于术后第1天开始降低,至术后第6天为最低.术后第7天始,上述黏附分子水平逐渐回升,至180 d,CD4,CD28,CD54水平一直低于术前水平,CD11a于术后20 d回升到术前水平,而CD8则持续升高,于术后30 d,明显超过术前水平(t=4.1,P＜0.05).结论:免疫抑制剂对黏附分子具有明显抑制作用.同种异体手移植术后患者无明显排斥反应与临床观察相符,提示黏附分子可作为排斥反应的监测指标,对提高移植手的存活率及其远期功能恢复具有重要意义.