CAJ | 학술논문

目的：研究供受者HLA-A、B、DRB1＆DQB1的相合率对移植肾近期效果的影响。方法：选择已完成供受者HLA基因分型，且术后持续随访＞13个月的358例初次肾移植移植受者，采集移植后首次发生急性排斥（AR）的时间、处理措施、AR恢复及肾功能情况，参照美国器官共享联合网络（UNOS）策略将供受者之间HLA-A、B、DRB1＆DQB1相合率0～8分组，共9个组，分析供受者之间HLA-A、B、DRB1＆DQB1的相合率及其与移植1年内AR和移植肾有功能生存的关联性。结果：358例移植肾供受者中，1年AR率为15.08％，分别比较HLA相合率0～8分组及以0～8分为节点的组合组间的AR率，其中1分组的AR率与3、4、5分组之间差异均具有统计学差异（P＜0.05），0～1分与2～8分组合组之间、0～2分与3～8分组合组之间以及0～3分与4～8分组合组之间差异均具有统计学差异（P＜0.05），其中0～2分与3～8分组合组相比差异性最大（2＝10.836）。1年人/肾存活率为95.81％，带功死亡率为1.40％（5例均为肺部感染），移植肾失功为2.80％；1年人/肾存活率从高到低依次为8分＝7分＝6分＞5分＞4分＞3分＞2分＞1分＞0分组，各组间差异均无统计学意义（P＞0.05）。结论：研究证实， HLA相合率对初次移植肾的近期效果具有显著影响，供受者间HLA 相合率越高，术后发生AR几率越低。但是HLA存在的高度多态性导致肾移植受者获得HLA-A、B、DRB1＆DQB1全相合供者的几率极低，因此，为了获得良好的肾移植近期效果，同时提高移植肾的长期存活率，初次肾移植受者应尽量选择供受者HLA相合率＞3分的供肾。
목적：연구공수자HLA-A、B、DRB1＆DQB1적상합솔대이식신근기효과적영향。방법：선택이완성공수자HLA기인분형，차술후지속수방＞13개월적358례초차신이식이식수자，채집이식후수차발생급성배척（AR）적시간、처리조시、AR회복급신공능정황，삼조미국기관공향연합망락（UNOS）책략장공수자지간HLA-A、B、DRB1＆DQB1상합솔0～8분조，공9개조，분석공수자지간HLA-A、B、DRB1＆DQB1적상합솔급기여이식1년내AR화이식신유공능생존적관련성。결과：358례이식신공수자중，1년AR솔위15.08％，분별비교HLA상합솔0～8분조급이0～8분위절점적조합조간적AR솔，기중1분조적AR솔여3、4、5분조지간차이균구유통계학차이（P＜0.05），0～1분여2～8분조합조지간、0～2분여3～8분조합조지간이급0～3분여4～8분조합조지간차이균구유통계학차이（P＜0.05），기중0～2분여3～8분조합조상비차이성최대（2＝10.836）。1년인/신존활솔위95.81％，대공사망솔위1.40％（5례균위폐부감염），이식신실공위2.80％；1년인/신존활솔종고도저의차위8분＝7분＝6분＞5분＞4분＞3분＞2분＞1분＞0분조，각조간차이균무통계학의의（P＞0.05）。결론：연구증실， HLA상합솔대초차이식신적근기효과구유현저영향，공수자간HLA 상합솔월고，술후발생AR궤솔월저。단시HLA존재적고도다태성도치신이식수자획득HLA-A、B、DRB1＆DQB1전상합공자적궤솔겁저，인차，위료획득량호적신이식근기효과，동시제고이식신적장기존활솔，초차신이식수자응진량선택공수자HLA상합솔＞3분적공신。
Aim:To study the impact of HLA-A、B、DRB1&DQB1 mismatch between recipient and do-nor on short-term effect of the renal transplant.Methods:Three hundred and fifty-eight cases of trans-plant recipients who accepted the initial renal transplant,PRA tested to be negative and had integrated donor and recipient HLA genotyping data were Chose.Time of first occurrence of acute rejection(AR) after transplantation,method of processing,restoration and renal function of AR were collected.Accord-ing to the mismatch degree of HLA-A,B,DR &DQ between donor and recipient by the UNOS method, 358 recipients which divided into nine groups that from 0 to 8 points’ group.Then analyzed donor/recipient’s HLA-A,B,DR&DQ mismatch rate and its association with acute rejection after transplanta-tion and the survival rate of 1 year after renal transplantation.Results:In 358 recipients,the acute re-jection incidence of 1 year was 23.1 3%.Compare the rate of AR in 0-8 points donor/recipient’s mis-match groups and 0-8 points combined groups,in which the 1 points group was significant differences to 3,4,5 points group respectively (P<0.05).And there were also statistically differences between 0-1 and 2-8 points combined group,0 -2 and 3 -8 points combined group,as well as 0 -3 and 4 -8 points combined group (P<0.05 ).And the maximum differences was between 0 -2 and 3 -8 points combined group (2 =1 0.84).In 358 recipients,1-year patient /graft survival rate was 95.81%, with a mortality rate of 1.40% (5 cases died of lung infection),graft loss rate was 2.80%;1-year pa-tient /graft survival rates in the order of 8 =7 =6 >5 >4 >3 >2 >1 >0 points group,and there were no statistically differences between each two groups (P>0.05 ).Conclusion:Our study con-firmed that HLA mismatch has a significant effect in short-term of renal transplant.The less HLA mis-match between donor/recipient,the lower the onset of postoperative AR.However,the presence of high-ly polymorphic in HLA gene leads to the chance of kidney transplant recipients receive a HLA-A,B, DRB1 &DQB1 full match kidney is very low.In order to get a good short-term effect of renal transplanta-tion,and improve the long-term graft survival,we believe that primary ranal transplant recipients should select a kidney that HLA-matches >3 points.