摘要
目的评价外周血嗜酸性粒细胞升高诊断肝移植6个月后发生的急性排斥反应（acuterejection．AR）的价值。方法回顾性分析肝移植术后肝穿刺活检患者的临床资料，根据病理确诊结果分为AR组和非AR组，比较2组患者肝穿刺当天或前1天血常规中白细胞的分类，比较嗜酸性粒细胞升高在早期（术后1个月内）、中期（1～6个月）和后期（6个月后）AR组中的发生率，并评价嗜酸性粒细胞升高诊断后期AR的敏感性和特异性。结果共185例次肝穿刺、161例肝移植患者资料入组，110例次AR，其中早期32例（29．1％）、中期54例（49．1％）、后期24例（21．8％）。AR组白细胞总数、中性粒细胞绝对值和相对值显著低于非AR组，但淋巴细胞相对值、嗜酸性粒细胞绝对值和相对值显著高于非AR组。嗜酸性粒细胞绝对值≥0．4×10^9／L或相对值≥4％共28例，其中AR组25例（22．7％），早期、中期和后期AR分别为2例（6．3％）、13例（24．1％）和10例（41．7％），嗜酸性粒细胞升高诊断后期AR的敏感性和特异性分别为41．7％和100％。结论肝移植术后急性排斥反应患者嗜酸性粒细胞显著高于非排斥患者，嗜酸性粒细胞升高对肝移植术后迟发性急性排斥反应具有很高的诊断价值。
Objective To evaluate the predictive value of increased eosinophil count in peripheral blood in the diagnosis of acute rejection （AR） occurred 6 months or later following liver transplantation （LT）. Methods The peripheral blood eosinophil count the day before or on the day of biopsy in 185 biopsies from 161 liver transplant patients were retrospectively analyzed. Patients were divided into AR group and non-acute rejection （NAR） group according to histopathologic findings. Differential white ceil counts were compared between two groups. The rates of increased eosinophil count were compared among early （ the first month post-transplant）, mid-term （from 1 to 6 months）, and late acute rejection （after 6 months） post-transplant. Absolute eosinophil count greater than 0.4 ×10^9/L or relative eosinophil count greater than 4% was defined as elevated. The sensitivity and specificity of increased eosinophil count for diagnosing late AR was calculated. Results Of the 185 liver biopsies, 110 were diagnosed as acute rejection, including 32 eases of early AR （29. 1% ） , 54 cases of mid-term AR （49.1% ） , and 24 cases of late AR （21.8%）. The overall white cell count, absolute and relative neutrophil count were significantly lower in the AR group than in the NAR group, while relative lymphocyte count, absolute and relative eosinophil count were significantly higher in the AR group than in the NAR group. There were 28 biopsies with an elevated eosinophil count. Of the 25 biopsies with elevated eosinophil count in AR group, only 2 （6. 3% ） were in early AR, with 13 in mid-term AR （24. 1% ） and 10 in late AR （41.7%）, respectively. The sensitivity and specificity of increased absolute and relative eosinophil count to predict late AR was 41.7% and 100% ,respectively. Conclusions Eosinophil counts in peripheral blood in AR group after LT are significantly higher compared with those in non-acute rejection group. Increased eosinophil count has high diagnostic value for diagnosing late acu
出处
《中华普通外科杂志》
CSCD
北大核心
2013年第3期178-181,共4页
Chinese Journal of General Surgery
基金
国家科技重大专项基金资助项目（2012ZX10002-017、023）
科技部973计划基金资助项目（2009CB522404）
国家自然科学举金资助项目（30972914、81000190、U0932006、81172036）
