中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2010年
6期
343-347
,共5页
侯建全%何军%袁晓妮%王乾%王云炎%李强%张江磊%李琛%鲍晓晶%邱桥成%李扬%温端改
侯建全%何軍%袁曉妮%王乾%王雲炎%李彊%張江磊%李琛%鮑曉晶%邱橋成%李颺%溫耑改
후건전%하군%원효니%왕건%왕운염%리강%장강뢰%리침%포효정%구교성%리양%온단개
肾移植%抗体%HLA抗原%基因,MHCⅠ类%移植物排斥%肾功能试验
腎移植%抗體%HLA抗原%基因,MHCⅠ類%移植物排斥%腎功能試驗
신이식%항체%HLA항원%기인,MHCⅠ류%이식물배척%신공능시험
Kidney transplantation%Antibodies%HLA antigens%Genes,MHC class Ⅰ%Graft rejection%Kidney function tests
目的 探讨抗HLA与抗主要组织相容性复合物Ⅰ类链相关基因A(MICA)抗体的表达对移植肾功能和急性排斥反应的预示作用.方法 采用免疫磁珠流式液相芯片技术检测41例肾移植受者移植前后的抗HLA和抗MICA抗体,其中37例接受了1、3、6个月及1、2、3年的动态随访.分析抗HLA和抗MICA抗体的特异性,及其与血清肌酐和排斥反应的相关性.结果 移植前共有9例(22.0%,9/41)预存抗HLA或(和)抗MICA抗体,其巾抗HLA抗体阳性2例(4.9%,2/41),抗MICA抗体阳性6例(14.6%,6/41),抗HLA和抗MICA抗体均阳性1例(2.4%,1/41).另外有5例抗MICA抗体可疑阳性.除1例的抗MICA抗体为供者特异性抗体(DSA)外,其余均为非供者特异性抗体(NDSA).37例随访者中,6例新生抗HLA抗体(16.2%),3例新生抗MICA抗体(8.1%),新生抗HLA抗体者的抗体滴度在随访3年中呈现上升趋势.9例预存抗体的受者,有4例(44.4%,4/9)发生排斥反应;6例新生抗HLA抗体的受者中,有3例(50.0%)发生急性排斥反应,而3例新生抗MICA抗体的受者均无排斥反应发生,二者间的差异有统计学意义(P＜0.05).新生抗HLA抗体产生较早(术后3 d和7 d)的2例受者均检测到抗HLAⅡ类DSA,其移植肾均因排斥反应而切除.预存抗MICA抗体,且移植后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于预存抗MICA抗体但无排斥反应者(P＜0.05);移植前抗HLA和抗MICA抗体均阴性者,术后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于抗体阴性且无排斥反应者(P＜0.01);无论是新生抗HLA抗体还是抗MICA抗体,移植后1个月发生排斥反应者的血肌酐均明显高于抗体阴性且无排斥反应者(P＜0.01).结论 预存和新生抗HLA抗体是移植后发生急性排斥反应的重要因素,而供、受者HLA和MICA基因错配是产生新生抗体的重要原因.
目的 探討抗HLA與抗主要組織相容性複閤物Ⅰ類鏈相關基因A(MICA)抗體的錶達對移植腎功能和急性排斥反應的預示作用.方法 採用免疫磁珠流式液相芯片技術檢測41例腎移植受者移植前後的抗HLA和抗MICA抗體,其中37例接受瞭1、3、6箇月及1、2、3年的動態隨訪.分析抗HLA和抗MICA抗體的特異性,及其與血清肌酐和排斥反應的相關性.結果 移植前共有9例(22.0%,9/41)預存抗HLA或(和)抗MICA抗體,其巾抗HLA抗體暘性2例(4.9%,2/41),抗MICA抗體暘性6例(14.6%,6/41),抗HLA和抗MICA抗體均暘性1例(2.4%,1/41).另外有5例抗MICA抗體可疑暘性.除1例的抗MICA抗體為供者特異性抗體(DSA)外,其餘均為非供者特異性抗體(NDSA).37例隨訪者中,6例新生抗HLA抗體(16.2%),3例新生抗MICA抗體(8.1%),新生抗HLA抗體者的抗體滴度在隨訪3年中呈現上升趨勢.9例預存抗體的受者,有4例(44.4%,4/9)髮生排斥反應;6例新生抗HLA抗體的受者中,有3例(50.0%)髮生急性排斥反應,而3例新生抗MICA抗體的受者均無排斥反應髮生,二者間的差異有統計學意義(P＜0.05).新生抗HLA抗體產生較早(術後3 d和7 d)的2例受者均檢測到抗HLAⅡ類DSA,其移植腎均因排斥反應而切除.預存抗MICA抗體,且移植後髮生排斥反應者在隨訪的每箇時間點上的血清肌酐水平均高于預存抗MICA抗體但無排斥反應者(P＜0.05);移植前抗HLA和抗MICA抗體均陰性者,術後髮生排斥反應者在隨訪的每箇時間點上的血清肌酐水平均高于抗體陰性且無排斥反應者(P＜0.01);無論是新生抗HLA抗體還是抗MICA抗體,移植後1箇月髮生排斥反應者的血肌酐均明顯高于抗體陰性且無排斥反應者(P＜0.01).結論 預存和新生抗HLA抗體是移植後髮生急性排斥反應的重要因素,而供、受者HLA和MICA基因錯配是產生新生抗體的重要原因.
목적 탐토항HLA여항주요조직상용성복합물Ⅰ류련상관기인A(MICA)항체적표체대이식신공능화급성배척반응적예시작용.방법 채용면역자주류식액상심편기술검측41례신이식수자이식전후적항HLA화항MICA항체,기중37례접수료1、3、6개월급1、2、3년적동태수방.분석항HLA화항MICA항체적특이성,급기여혈청기항화배척반응적상관성.결과 이식전공유9례(22.0%,9/41)예존항HLA혹(화)항MICA항체,기건항HLA항체양성2례(4.9%,2/41),항MICA항체양성6례(14.6%,6/41),항HLA화항MICA항체균양성1례(2.4%,1/41).령외유5례항MICA항체가의양성.제1례적항MICA항체위공자특이성항체(DSA)외,기여균위비공자특이성항체(NDSA).37례수방자중,6례신생항HLA항체(16.2%),3례신생항MICA항체(8.1%),신생항HLA항체자적항체적도재수방3년중정현상승추세.9례예존항체적수자,유4례(44.4%,4/9)발생배척반응;6례신생항HLA항체적수자중,유3례(50.0%)발생급성배척반응,이3례신생항MICA항체적수자균무배척반응발생,이자간적차이유통계학의의(P＜0.05).신생항HLA항체산생교조(술후3 d화7 d)적2례수자균검측도항HLAⅡ류DSA,기이식신균인배척반응이절제.예존항MICA항체,차이식후발생배척반응자재수방적매개시간점상적혈청기항수평균고우예존항MICA항체단무배척반응자(P＜0.05);이식전항HLA화항MICA항체균음성자,술후발생배척반응자재수방적매개시간점상적혈청기항수평균고우항체음성차무배척반응자(P＜0.01);무론시신생항HLA항체환시항MICA항체,이식후1개월발생배척반응자적혈기항균명현고우항체음성차무배척반응자(P＜0.01).결론 예존화신생항HLA항체시이식후발생급성배척반응적중요인소,이공、수자HLA화MICA기인착배시산생신생항체적중요원인.
Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.
