CAJ | 학술논문

目的探讨致敏肾移植受者(群体反应性抗体PRA＞20%)主要组织相容性复合物I类链相关基因A抗体(MICA-Ab)的表达对患者预后的影响.方法收集本院2007年8月至2010年4月行肾移植的致敏受者51例,其中29例接受蛋白A免疫吸附,并在吸附前后行MICA-Ab检查;另22例未接受免疫吸附,在入院时行MICA-Ab检查.回顾分析移植受者人类白细胞抗原(HLA)、急性排斥反应、术后1周和4周Scr水平与MICA-Ab的关系.结果 51例受者中16例MICA-Ab表达阳性(31.4%),MICA-Ab表达阴性与阳性受者的急性排斥发生比例差异无统计学意义.PRA＞40%受者的MICA-Ab表达显著高于PRA≤40%受者(P＜0.05).HLA错配对MICA-Ab表达无显著影响.在接受免疫吸附受者中,MICA-Ab阳性组和阴性组出院时Scr水平差异无统计学意义;未接受免疫吸附受者情况相似.MICA-Ab水平在蛋白A免疫吸附后显著下降.结论 MICA-Ab在致敏受者中表达升高,然而对受者预后无显著影响.蛋白A免疫吸附可有效去除致敏受者体内MICA-Ab.
목적 탐토치민신이식수자(군체반응성항체PRA＞20%)주요조직상용성복합물I류련상관기인A항체(MICA-Ab)적표체대환자예후적영향.방법 수집본원2007년8월지2010년4월행신이식적치민수자51례,기중29례접수단백A면역흡부,병재흡부전후행MICA-Ab검사;령22례미접수면역흡부,재입원시행MICA-Ab검사.회고분석이식수자인류백세포항원(HLA)、급성배척반응、술후1주화4주Scr수평여MICA-Ab적관계.결과 51례수자중16례MICA-Ab표체양성(31.4%),MICA-Ab표체음성여양성수자적급성배척발생비례차이무통계학의의.PRA＞40%수자적MICA-Ab표체현저고우PRA≤40%수자(P＜0.05).HLA착배대MICA-Ab표체무현저영향.재접수면역흡부수자중,MICA-Ab양성조화음성조출원시Scr수평차이무통계학의의;미접수면역흡부수자정황상사.MICA-Ab수평재단백A면역흡부후현저하강.결론 MICA-Ab재치민수자중표체승고,연이대수자예후무현저영향.단백A면역흡부가유효거제치민수자체내MICA-Ab.
Objective To explore the effect of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients.Methods A total of 51 sensitized recipients (PRA more than 20%) in our hospital from August 2007 to April 2010 were enrolled in the study.In these patients,29 cases received protein A immunoadsorption and detection of MICA-Ab was performed before and after protein A immunoadsorption.Other 22 patients received MICA-Ab detection when they were hospitalized.Associations of PRA,HLA-matches,acute rejection,and serum creatinine of postoperative week 1 and week 4 with MICA-Ab were analyzed retrospectively.Results Sixteen recipients (31.4%) had positive MICA-Ab expression but their acute rejection rate was not higher as compared to the patients with negative MICA-Ab expression.Recipients with PRA＞40% showed higher expression level of MICA-Ab than recipients with PRA≤40% (P≤0.05).HLA-match did not show influence on MICA-Ab expression.MICA-Ab positive group had no higher serum creatinine level than negative group in postoperative week 4.MICA-Ab level decreased significantly after protein A immunoadsorption.Conclusions MICA-Ab expression increases in the sensitive recipients but does not influence the prognosis.Protein Aimmunoadsorption can eliminate MICA-Ab effectively in sensitized recipients.