| BackgroundAllograft renal transplantation already became the major channel of therapyin terminal stage renal failure (toxuria) because of various kinds of reason.。Buthow to elevate the patient/kidney survival rate of long-term,preclude acuterejection (AR),,prevent cyclosporine nephrotoxic,infection prevention,decrease adverse reaction are still the problems that the clinical doctorsresearched on.With the unceasing development of research in transplantationimmunology, the mechanism of action of various kinds of cell factor aregradually clear, which make it possible to search new therapeutic tool and newmonitoring index on level of cell factor.ObjectiveThe aim of this study is to identify the object concentration of C2 in humanone month after operation , sIL-2R can be the routine examination to precludeacute rejection and lower the nephrotoxicity of CsA in kidney transplantation ornot .The concrete step is to monitoring the C2 and sIL-2R, activity ofcalcineurin ,to research the relationship between them on different lateralplane.Contrast the coincide level between the activity of calcineurin and theresult of sIL-2R.To adjust the concentration of C2 more precise and in time,preclude acute rejection and guide the clinical medication.MethodThis study adoption 48 allograft renal transplantation patients because offinal stage renal failure from October of 2004 to June of 2005, these were alltransplantation patients for the first time.Of the total, 6 cases of reject reaction,3cases of toxicosis.They were applied trigeminy immunological inhibitionplan(CsA+Mycophenolate+Prednisonum).The contrast were 30 healthy peoplefrom medical examination center.All the patients were divided into 3 groups:①T he group of normal recover in renal function(n=39);②The group of acuterejection(AR)(n=6);③T he group of Cyclosporine Nephrotoxic(CN)(n=3).Standard of judge in acute rejection and acute toxicosis in liver and kidney:Diagnose of acute rejection:body temperature heighten suddenly ,hypourocrinia,body weight gain,blood pressure step up,renal regionintumesce,hard,tenderness and accompany with different general symptom ofdebility,fatigue,aching pain in joints,headache,abdominal distension,pyknosphygmia and restlessness. Hypourocrinia was the main index of acuterejection,and also the earliest symptom,about 80%.Creatinine of sirum surpassed30% of origin level.Diagnose of acute Cyclosporine Nephrotoxic of liver: Except other factors,hemobilirubin of patients ≥34.2umol/L,ALT or AST was enhanced, even AKPwas enhanced.When immunosuppressive decremented, humobilirubin,ALT,AST,AKP were recovered.Diagnose of acute Cyclosporine Nephrotoxic of kidney: the breakdown ofserum creatinine stoped or enhanced slowly, urinary production were decreased,reabsorb of Mg2+ decreased,secrete of K+ and H+ reduced, evacuate oftriketopurie reduced. After the CsA decreased, symptoms were improved soon.ResultsLevel of sIL-2R in 48 cases of kidney transplant patients was assumedmormal distribution.The level of sIL-2R in preoperative patients was higher thanhealth adult. After operation, the level sIL-2R decreased quickly in no-rejectionpatients and CN patients, which decreased slowly in patients who haverejection(Attached table 1). The degression of sIL-2R were 7.8% and 36.6% inrejection group and no-rejection group, there was significant difference betweenthem.When the reject reaction happened, the coefficient correlation betweensIL-2R and Cr was 0.73.(0.05>P>0.01)When the concentration of C2 higher than the top limit (1650 ng·mL-1)of therapeutic window, the incidence rate of toxonosis was 10.71%~26.19%. Butwhen it lower than the top limi(t1650 ng·mL-1), the incidence rate of toxonosiswas 2.14%-2.98%.The two groups have significant difference.When the concentration of C2 lower than the low limit (1100 ng·mL-1)of therapeutic window, the incidence rate of toxonosis was 15.38%-46.43%.But when it higher than the low limit(1100 ng·mL-1), the incidence rate oftoxonosis was 4.28%-6.94%.The two groups have significant difference.The activity of PBMC and CaN changed greatly in rejection group,no-rejection group and CN group before and after the operation. It can beregarded as the monitoring index of preventing AR and avoiding toxic.Conclusion(1)When the reject reaction happened, the level of sIL-2R enhancedobviously, arrived 1000U/ml or surpassed it.The lowest was advanced 350 U/mlbefore rejection.It was happened ahead of clinical symptom and Cr in bloodenhanced for three to five days.(2)Detect the level of sIL-2R,it can be regarded as an index ofdistinguishing CN and rejection.(3) sIL-2R was not the specificity index in judging rejection.The rejectionthat because of renal failure due to renal artery stenosis and hemolytic-uremicsyndrome, sIL-2R was not enhanced .Blood transfusion,bacterium,viralinfection can induced the enhance of sIL-2R.(4) sIL-2R can be regarded as important aid early warning monitoringindex to AR.(5) On the basis of our monitoring on C2, when we use the tripleimmunosuppressive therapy,fluorescence polarization immunologic assay candirect the clinical medication easily.The ideal therapeutic window of C2: thethird day after operation (1321.51±252.25)ng·mL-1,the seventh day afteroperation (1430. 36±241.36) ng·mL-1 , the fourteenth day after operation(1241.39±220.61) ng·mL-1 , the twentieth day after operation (1230.61±200.86)ng·mL-1.In this ambit,the effect of immunological inhibition was satisfied,it canbe regarded as the reference of therapeutic window concentration in receptorone month after transplantation.
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