CAJ | 학술논문

目的探讨肾移植后发生急性体液性排斥反应(AHR)的可能机制,及其在临床早期诊断和防治AHR中的重要意义.方法回顾分析2006年1月至2010年12月间296例肾移植受者的临床资料.肾移植术后,采用酶联免疫吸附试验(ELISA)动态监测受者群体反应性抗体(PRA)和供者特异性抗体(DSA)水平,采用免疫组织化学法和HE染色检查移植肾组织的病理形态学改变及C4d的沉积、浸润淋巴细胞表面分子标记.AHR诊断标准参照Banff 2005标准,并结合受者的临床相关指标.结果 296例受者中,术后共有25例发生了AHR,发生率为8.4％ (25/296).术前PRA阳性者和阴性者术后AHR的发生率分别为23.1％(6/26)和7.0％(19/270),两者比较,差异有统计学意义(P＜0.01).术后发生AHR和未发生AHR受者的DSA阳性率分别为88.0％(22/25)和0.4％(1/271),出现C4d沉积阳性率分别为80.0％(20/25)和6.7％ (4/60),两者间DSA阳性率和C4d沉积阳性率的比较,差异均有统计学意义(P＜0.01).通过调整免疫抑制方案和(或)应用静脉注射免疫球蛋白、血浆置换、抗胸腺细胞球蛋白及利妥昔单抗等治疗后,19例AHR被逆转,其余6例因治疗无效,发生移植肾破裂,导致移植肾被切除.结论 PRA和DSA在肾移植术后AHR的发生中起重要作用,术后应立即开始监测PRA和DSA,以达到预防、早期诊断和合理治疗AHR的目的,进而改善移植肾的存活.
목적 탐토신이식후발생급성체액성배척반응(AHR)적가능궤제,급기재림상조기진단화방치AHR중적중요의의.방법 회고분석2006년1월지2010년12월간296례신이식수자적림상자료.신이식술후,채용매련면역흡부시험(ELISA)동태감측수자군체반응성항체(PRA)화공자특이성항체(DSA)수평,채용면역조직화학법화HE염색검사이식신조직적병리형태학개변급C4d적침적、침윤림파세포표면분자표기.AHR진단표준삼조Banff 2005표준,병결합수자적림상상관지표.결과 296례수자중,술후공유25례발생료AHR,발생솔위8.4％ (25/296).술전PRA양성자화음성자술후AHR적발생솔분별위23.1％(6/26)화7.0％(19/270),량자비교,차이유통계학의의(P＜0.01).술후발생AHR화미발생AHR수자적DSA양성솔분별위88.0％(22/25)화0.4％(1/271),출현C4d침적양성솔분별위80.0％(20/25)화6.7％ (4/60),량자간DSA양성솔화C4d침적양성솔적비교,차이균유통계학의의(P＜0.01).통과조정면역억제방안화(혹)응용정맥주사면역구단백、혈장치환、항흉선세포구단백급리타석단항등치료후,19례AHR피역전,기여6례인치료무효,발생이식신파렬,도치이식신피절제.결론 PRA화DSA재신이식술후AHR적발생중기중요작용,술후응립즉개시감측PRA화DSA,이체도예방、조기진단화합리치료AHR적목적,진이개선이식신적존활.
Objective To investigate the possible mechanisms of acute humoral rejection (AHR) after renal transplantation and the significance of early diagnosis and prevention.Methods The clinical data of 296 cases receiving renal transplantations from January 2006 to December 2010 were retrospectively analyzed. After renal transplantation,the dynamic changes of panel reactive antibodies (PRA) and donor specific antibodies (DSA) in peripheral blood were monitored by using ELISA,and C4d deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by using immunohistochemistry.The AHR was diagnosed according to Banff 2005 criteria and clinical related indexes. Results Among 296 patients,25 were diagnosed as AHR after transplantation with the incidence being 8.4％ (25/296).The AHR incidence after transplantation in patients positive and negative for PRA before transplantation was 23.1 ％ (6/26) and 7.0％ (19/270) respectively (P＜0.01).The DSA positive rate in the recipients with AHR and without AHR after transplantation was 80.0％ (20/25) and 6.7％ (4/60) respectively.Thcrc was significant difference in DSA and C4d positive rate between AHR and non-AHR patients (P＜0.001).By adjusting several therapies, such as the immunosuppressive program and (or) application of intravenous immunoglobulin,plasmapheresis,antithymocyte globulin and rituximab monoclonal antibody, 19 cases of AHR were reversed,and the remaining 6 cases had rupture of renal allograft due to ineffective treatment,leading to the removal of the transplanted kidney.Conclusion PRA and DSA were important for AHR after renal transplantation.Immediately monitoring of the PRA and DSA after transplantation is recommended in order to achieve the purposes of prevention,early diagnosis and rational treatment for AHR,thus improving the survival of the transplanted kidney.