CAJ | 학술논문

目的：建立一种分析应用群体反应性抗体（PRA）阳性患者与供者不相容几率的校正PRA（CPRA）方法，采用校正PRA (CPRA)方法分析临床肾移植中受者获得移植物的几率。方法计算2000年1月~2012年12月间2004例移植供者HLA-A、B、DR基因以及A-B、A-DR、B-DR和A-B-DR单倍型出现的频率作为HLA数据库，对202例PRA阳性患者的CPRA进行分析，并评价PRA和CPRA的一致性。结果本研究基于2004例移植供者的HLA设计的CPRA-Java计算软件，从中输入PRA阳性受者的HLA特异性抗体，即可获得一个CPRA的百分数，代表受者不可接受的HLA基因在供者群体中存在的几率。202例PRA阳性受者平均强度为（23.12±17.83）%，CPRA均值为（46.07±23.30）%。低度致敏组（PRA>0~10%）的平均强度（6.87±2.41）%与组中CPRA均值（21.63±11.75）%之间存在显著的统计学差异（P<0.05）；中度致敏组（PRA>10~30%）的平均强度为（20.15±5.70）%与组中CPRA均值（50.56±16.86）%之间存在显著的统计学差异（P<0.05）；高度致敏组（PRA>30%）中两值无显著的统计学差异（P>0.05）。低度、中度致敏组中PRA强度与CPRA值的一致率为19.35%和10.99%（P<0.05），高度致敏中PRA强度与CPRA值的一致率为100%（P>0.05）。结论研究证明，PRA呈低度致敏时受者实际获得移植的几率可能比PRA强度反映的低；而PRA>30%时CPRA均>30%，证实PRA>30%为肾移植的高危因素。研究表明，PRA反映了肾移植受者自身的致敏程度，可靠的HLA抗体特异性检测极为重要，而CPRA则可以如实反映受者获得移植的几率，为临床医师预测受者等待时间、选择移植方式提供依据。
목적：건립일충분석응용군체반응성항체（PRA）양성환자여공자불상용궤솔적교정PRA（CPRA）방법，채용교정PRA (CPRA)방법분석림상신이식중수자획득이식물적궤솔。방법계산2000년1월~2012년12월간2004례이식공자HLA-A、B、DR기인이급A-B、A-DR、B-DR화A-B-DR단배형출현적빈솔작위HLA수거고，대202례PRA양성환자적CPRA진행분석，병평개PRA화CPRA적일치성。결과본연구기우2004례이식공자적HLA설계적CPRA-Java계산연건，종중수입PRA양성수자적HLA특이성항체，즉가획득일개CPRA적백분수，대표수자불가접수적HLA기인재공자군체중존재적궤솔。202례PRA양성수자평균강도위（23.12±17.83）%，CPRA균치위（46.07±23.30）%。저도치민조（PRA>0~10%）적평균강도（6.87±2.41）%여조중CPRA균치（21.63±11.75）%지간존재현저적통계학차이（P<0.05）；중도치민조（PRA>10~30%）적평균강도위（20.15±5.70）%여조중CPRA균치（50.56±16.86）%지간존재현저적통계학차이（P<0.05）；고도치민조（PRA>30%）중량치무현저적통계학차이（P>0.05）。저도、중도치민조중PRA강도여CPRA치적일치솔위19.35%화10.99%（P<0.05），고도치민중PRA강도여CPRA치적일치솔위100%（P>0.05）。결론연구증명，PRA정저도치민시수자실제획득이식적궤솔가능비PRA강도반영적저；이PRA>30%시CPRA균>30%，증실PRA>30%위신이식적고위인소。연구표명，PRA반영료신이식수자자신적치민정도，가고적HLA항체특이성검측겁위중요，이CPRA칙가이여실반영수자획득이식적궤솔，위림상의사예측수자등대시간、선택이식방식제공의거。
Objective To establish a calculated panel reactive antibody (CPRA) method to analyze the donor-recipient incompatibility rate in PRA-positive kidney recipients and estimate the probability of these recipients to receive kidney transplantation. Methods Based on the database of HLA-A,-B,-DR genes and A-B, A-DR, B-DR, A-B-DR haplotype frequencies collected from 2004 donors from Jan 2000 to Dec 2012, we analyzed CPRA in 202 PRA-positive recipients and evaluated the consistency between PRA and CPRA assessments using a CPRA-Java calculator software, which returned a percentage of CPRA (representing the probability of unacceptable HLA in the donor group) after input of HLA-specific antibodies of a PRA-positive recipient. Result The mean PRA intensity of the 202 PRA-positive recipients was (23.12 ± 17.83)%with a mean CPRA% of (46.07 ± 23.30)%. A significant difference was found between the mean PRA% and CPRA% in low sensitized recipients (PRA 0-10%) [(6.87 ± 2.41)%vs (21.63 ± 11.75)%, P<0.05) and in moderately sensitized recipients (PRA 10%-30%) [(20.15 ± 5.70)% vs (50.56 ± 16.86)%, P<0.05), but not in highly sensitized recipients (PRA> 30%); The concordance rates between PRA% and CPRA% in the 3 groups were 19.35% (P<0.05), 10.99% (P<0.05), and 100% (P>0.05), respectively. Conclusions Lowly sensitized kidney recipients might have a lower probability of actually receiving a transplant than PRA%shows. A PRA%>30% is a risk factor for kidney transplantation. PRA reflects the sensitized level of a renal recipient, and reliable detection of HLA antibody specificity is of critical importance. CPRA accurately reflects the probability of a recipient to receive a transplant to assist clinicians in predicting the waiting time and selecting the transplant approach.