目的:肺移植是终末期肺病患者的救命方法。T细胞受体切除环(TREC)是在胸腺中的T细胞受体基因重排期间产生的环状DNA,并且指示初始T细胞从胸腺迀移。因此,其水平代表胸腺T细胞输出。移植后淋巴细胞动力学与移植物耐受性相关。这项研究的目的是研究肺移植后早期恢复期的T淋巴细胞动力学。为此,在肺移植患者中确定了TREC的拷贝数.此外,根据年龄评估TREC拷贝数,肺移植患者的诊断和1秒用力呼气容积(FEV1)。
方法:在胸外科诊所接受肺移植的23至59岁患者的外周血样本,Kartal-Košuyolu高级专业化教育和研究医院。这项研究包括11例肺移植患者的外周血样本(包括4例慢性阻塞性肺疾病患者,三个患有特发性肺纤维化,一个患有囊性纤维化,一个患有矽肺病,两个患有支气管扩张;总共三名女性)。在三个不同的时间点取样:移植前,移植后24小时和7天。用实时逆转录酶-聚合酶链反应分析TREC拷贝数。
结果:移植后的TREC数量和密度值高于移植前的值,尽管这些差异在统计学上无统计学意义。发现TREC拷贝数在45岁以下的患者中明显高于45岁以上的患者。移植后24小时,发现FEV1值为或低于50%的病例的平均TREC拷贝数/外周血单核细胞在统计学上显著高于FEV1值高于50%的病例(p=0.046).男性和女性患者之间或诊断组之间的TREC拷贝数没有统计学上的显着差异。
结论:TREC拷贝数可作为肺移植的预后指标。需要对更多患者进行多中心研究。
OBJECTIVE: Lung transplantation is a life-saving procedure for patients with end-stage lung diseases. T-Cell receptor excision circle (
TREC) is circular DNA produced during T-cell receptor gene rearrangement in the thymus and indicates naive T-cell migration from the thymus. Therefore, its levels represent thymic T-cell output. Post-transplant lymphocyte kinetics correlate with graft tolerance. The aim of this study was to investigate T-lymphocyte kinetics in the early recovery period after lung transplantation. For this purpose, copy numbers of
TREC were determined in patients with a lung transplant. In addition, TREC copy numbers were evaluated according to age, diagnosis and the forced expiratory volume in 1 second (FEV1) of lung transplant patients.
METHODS: Peripheral blood samples were taken from patients aged 23 to 59 years who underwent lung transplantation at the Thoracic Surgery Clinic, Kartal-Koşuyolu High Specialization Educational and Research Hospital. This study included peripheral blood samples from 11 lung transplant patients (comprising four with chronic obstructive pulmonary disease, three with idiopathic pulmonary fibrosis, one with cystic fibrosis, one with silicosis and two with bronchiectasis; three females in total). Samples were taken at three different timepoints: Before transplant, and 24 hours and 7 days post transplant.
TREC copy numbers were analyzed with real time reverse transcriptase-polymerase chain reaction.
RESULTS: Post-transplant TREC numbers and density values were higher compared to pre-transplant values, although these differences were statistically insignificant.
TREC copy numbers were found to be significantly higher in patients younger than 45 years compared to patients older than 45 years. At 24 hours after the transplant, the average
TREC copy number/peripheral blood mononuclear cells of the cases with an FEV1 value of or below 50% was found to be statistically significantly higher than that of cases with an FEV1 value above 50% (p=0.046). There was no statistically significant difference in TREC copy numbers between male and female patients or by diagnostic group.
CONCLUSIONS: TREC copy numbers can be evaluated as a prognostic marker for lung transplantation. There is a need for multicenter studies with more patients.