肾移植后监测肿瘤坏死因子与环孢素A血药浓度的临床意义

目的 研究肾移植术后患者肿瘤坏死因子(TNF)与全血环孢素A (CsA)浓度的临床意义。方法 采用放射免疫法测定血清和尿 TNF, FPIA 法测定 CsA 全血浓度。结果 急性排斥组患者血、尿 TNF(1.03±0.26 ng/L, 0.44±0.36ng/L)明显高于肾功能稳定组 (0.86±0.21 ng/L, 0.34± 0.29 ng/L), 并且可早于血肌酐升高 1～ 3d。而 CsA 肾中毒组的血 、尿 TNF(0.91±0.22ng/L 、 0.40±0.27ng/L)与肾功能稳定组无明显差别。CsA 血药浓度在急性排斥反应组明显降低, 而 CsA 肾中毒组显著升高。结论 TNF 和 CsA 血药浓度测定有助于鉴别急性排斥反应和CsA 肾中毒, 具有重要的临床意义。

The clinical significance of detecting tumor necrosis factor and blood concentration of cyclosporin A and in renal transplanted recipients

Aim To evaluate the clinical significance of determination of serum or urine tumor necrosis factos (TNF)and whole blood concentration of cyclosporin A (CsA)in renal transplanted recipients.Methods The serum and urine TNF levels with radioimmunoassay and whole blood concentration of CsA with FIPA method were determined in 55 renal transplanted re-cipients.Results Serum and urine TNF levels in group of acute rejection (1.03±0.26 ng/ L, 0.44±0.36 ng/L)were significantly higher than those in group of functionally stable re-nal graft(0.86±0.21ng/L, 0.34±0.29 ng/L)and there was an obvious elevation of the TNF as early as 1～ 3 daysbefore the rise of serum creatine.But the TNF levels in CsA nephrotoxicity group (0.91±0.22 ng/L, 0.4±0.27 ng/L)were not significantly different from those in func-tionally stable renal graft group. The blood concentration of CsA was decreased in group of acute rejection and increased in group of CsA nephrotoxicity. Conclusion Determining TNF and CsA could distinguished the graft rejection from CsA nephrotoxocity. It has important clinical sig-nificance for regulation of the dosage of CsA.