Abstract:

Objective To explore the expression of helper T cell 17（Th17）/regulatory T cell（Treg）levels in kidney transplant patients and their predictive value for the occurrence of pulmonary infections. Methods A total of 74 patients with kidney transplantation from January 2020 to December 2022 in People's Hospital ofXinjiang Uygur Autonomous Region were analysed in the study. The proportion of Th17 and Treg cells in peripheral blood was detected before and 2 months after surgery，and the Th17/Treg level was calculated. Patients werefollowed up for 1 year after surgery，and were divided into infected group and non infected group accordingto postoperative pulmonary infection. We focused on the ratio of Th17/Treg cells in renal transplant patients，and analyzed the predictive value of Th17/Treg ratio for postoperative pulmonary infection in renal transplant patients. Results There was a statistical significant difference in preoperative Th17/Treg ratio in kidney transplant patients with or without smoking history，diabetes，hypoproteinemia，and pulmonary infection history（P ＜ 0.05）. During the follow-up period of 74 kidney transplant patients，there were 21 cases of concurrent pulmonary infections，with an incidence rate of 28.38%（21/74）. The proportion of smoking history，diabetes，hypoproteinemia，and pulmonary infection history in the infected group was higher than that in the uninfected group，and the Tac blood concentration was higher than that in the uninfected group 2 months after surgery. The proportion of Treg cells in peripheral blood before and after surgery was lower than that in the non infected group，while the proportion of Th17 cells and Th17/Treg ratio were higher than those in the non infected group（P ＜ 0.05）. The results of plotting the receiver operating characteristic（ROC）curve showed that the AUC values of Th17，Treg cell ratio，and Th17/Treg level predicting postoperative pulmonary infection in kidney transplant patients were all ≥ 0.7 before surgery and 2 months after surgery，with a certain predictive value. Among them，the preoperative Th17/Treg ratio had a more ideal predictive value. Conclusion The elevated level ofTh17/Treg in renal transplant patients may participate in the process of pulmonary infection in renal transplant patients，and the high expression of Th17/Treg may be related to a history of smoking，diabetes and other risk factors for pulmonary infection；Preoperative examination of Th17/Treg ratio in patients can effectively predict the risk of postoperative pulmonary infection. 

Key words:

Renal failure , Kidney transplantation , Helper T cells 17 , Regulatory Tcells, Pulmonary infection, Prediction

摘要：

目的 探讨辅助性 T 细胞 17（helper T cell 17，Th17）/ 调节性 T 细胞（regulatory T cell，Treg）水平在肾移植患者中的表达及其对肺部感染发生的预测价值。 方法 回顾性分析 2020 年 1 月至2022 年 12 月新疆维吾尔自治区人民医院 74 例肾移植患者的临床资料。患者于术前、术后 2 个月时检测外周血 Th17、Treg 细胞比例，计算 Th17/Treg 水平。患者术后完成 1 年随访，依据患者术后肺部感染情况分为感染组、非感染组。重点观察 Th17/Treg 细胞在肾移植患者中的表达，并分析 Th17/Treg 对肾移植患者术后肺部感染的预测价值。结果 有无吸烟史、糖尿病、低蛋白血症、肺部感染史的肾移植患者术前 Th17/Treg

水平比较，差异有统计学意义（P ＜ 0.05）。74 例肾移植患者随访期间并发肺部感染 21 例，发生率为 28.38%（21/74）。感染组有吸烟史、糖尿病、低蛋白血症、肺部感染史占比高于非感染组，术后 2 个月他克莫司血药浓度高于非感染组 ；术前、术后外周血 Treg 细胞比例均低于非感染组，Th17 细胞比例、Th17/Treg 水平均高于非感染组（P ＜ 0.05）。绘制操作者工作特征（receiver operating characteristic，ROC）曲线结果显示，术前、术后 2 个月时 Th17、Treg 细胞比例、Th17/Treg 水平预测肾移植患者术后并发肺部感染的 AUC 值均≥ 0.7，均有一定预测价值，其中术前 Th17/Treg 水平预测价值更理想。 结论 肾移植患者 Th17/Treg 水平升高可能参与肾移植患者术后肺部感染发生过程，且高表达者多存在吸烟史、合并糖尿病等发生肺部感染的危险因素，术前检查患者 Th17/Treg 水平可有效预测术后并发肺部感染风险。

关键词: 肾功能衰竭 , 肾移植 , 辅助性 T 细胞 17 , 调节性 T 细胞 , 肺部感染 , 预测