CAJ | 학술논문

目的监测肾移植受者术后抗HLA抗体水平,探讨新生的抗HLA抗体对移植肾功能的影响.方法共有384例肾移植受者术后进行了抗HLA抗体的监测,监测时间3～96个月,所有受者术前的抗HLA抗体水平均为阴性.使用莱姆德抗原板,采用酶联免疫吸附法(ELISA)检测抗HLA抗体,抗HLA抗体水平＞10%为阳性.对术后抗HLA抗体阳性者与阴性者间移植肾功能进行比较,观察新生抗HLA抗体对移植肾功能的影响.结果术后抗HLA抗体阴性者318例(82.8%);阳性者66例(17.2%),其中抗HLA Ⅰ类抗体阳性者3例,抗HLAⅡ类抗体阳性者61例,抗HLA Ⅰ类和Ⅱ类抗体均为阳性者2例.HLA-DR位点0个抗原错配者92例受者中有7例新生抗HLA抗体,1～2个抗原错配者292例中有59例新生抗HLA抗体,二者比较,差异有统计学意义(P＜0.01).术后抗HLA抗体阴性者中移植肾功能良好者占87.4%(278/318),抗HLA抗体阳性者中移植肾功能良好者占65.2%(43/66),二者比较,差异有统计学意义(P＜0.05).结论 HLADR位点的抗原错配与肾移植后抗HLA抗体的产生密切相关,而新生抗HLA抗体会造成移植肾功能下降,从而降低移植存活率,肾移植术后监测抗HLA抗体有一定的临床意义.
목적 감측신이식수자술후항HLA항체수평,탐토신생적항HLA항체대이식신공능적영향.방법 공유384례신이식수자술후진행료항HLA항체적감측,감측시간3～96개월,소유수자술전적항HLA항체수평균위음성.사용래모덕항원판,채용매련면역흡부법(ELISA)검측항HLA항체,항HLA항체수평＞10%위양성.대술후항HLA항체양성자여음성자간이식신공능진행비교,관찰신생항HLA항체대이식신공능적영향.결과 술후항HLA항체음성자318례(82.8%);양성자66례(17.2%),기중항HLA Ⅰ류항체양성자3례,항HLAⅡ류항체양성자61례,항HLA Ⅰ류화Ⅱ류항체균위양성자2례.HLA-DR위점0개항원착배자92례수자중유7례신생항HLA항체,1～2개항원착배자292례중유59례신생항HLA항체,이자비교,차이유통계학의의(P＜0.01).술후항HLA항체음성자중이식신공능량호자점87.4%(278/318),항HLA항체양성자중이식신공능량호자점65.2%(43/66),이자비교,차이유통계학의의(P＜0.05).결론 HLADR위점적항원착배여신이식후항HLA항체적산생밀절상관,이신생항HLA항체회조성이식신공능하강,종이강저이식존활솔,신이식술후감측항HLA항체유일정적림상의의.
Objective To detect de novo development of anti-HLA antibodies after renal transplantation, and to investigate their influence on graft function. Methods 384 kidney recipients,who were negative for anti-HLA antibody before transplantation, were monitored for anti-HLA antibodies over a period of 3-96 months, and a sensitive enzyme-linked immunosorbent assay (ELISA) was used to detect anti-HLA antibodies. HLA antibody ＞10 % was defined as positive levels. Results Among 384 recipients tested, 318 recipients (82. 8 %) were negative for anti-HLA antibody after transplantation; 66 recipients (17. 2 %) developed de novo HLA antibodies, 3 recipients with HLA class Ⅰ, 61 with HLA class Ⅱ, 2 with both HLA class Ⅰ and Ⅱ. According to amino acid residue matching, 7 cases developed de novo antibodies among 92 recipients with 0 HLA-DR mismatches,compared with 59 cases among 292 recipients with 1-2 mismatches, which showed significant difference between two groups (P＜0. 01 ). 87. 4 % (278/318) recipients negative for HLA antibodies after transplantation achieved good graft function, in comparison with 65. 2 % (43/66) recipients positive for HLA antibodies (P＜0. 05). Conclusion De novo production of HLA antibodies posttransplantation may be closely associated with HLA-DR mismatch. De novo HLA antibodies posttransplantation might damage graft function and reduce graft survival rate. The detection of de novo development of anti-HLA antibodies after renal transplantation has clinical significance for assessing renal allograft function.