CAJ | 학술논문

目的应用单抗原珠技术动态监测肾移植受者体内供者特异性抗体(DSA)及出现DSA阳性后早期干预治疗的临床效果.方法采用免疫荧光液相芯片(Luminex)单抗原珠技术动态监测64例亲属活体供肾移植受者移植前后的DSA情况,对DSA阳性受者给予大剂量静脉注射免疫球蛋白(WIG)和增加吗替麦考酚酯(MMF)剂量的干预治疗,并分析DSA对移植肾功能的影响.结果 64例受者术前检测DSA均为阴性.术后监测发现10例DSA阳性.DSA阳性受者均为供、受者HLA抗原错配的受者.10例DSA阳性受者经干预治疗后,其中2例DSA转阴,6例DSA免疫荧光强度下降超过50％,2例DSA无明显下降.2例干预治疗无效的受者在3～6个月后出现抗体介导的排斥反应导致移植肾功能损害.结论应用单抗原珠技术动态监测DSA的效果较好,早期应用大剂量IVIG和增加MMF剂量的干预治疗可有效减少受者体内的DSA.
목적 응용단항원주기술동태감측신이식수자체내공자특이성항체(DSA)급출현DSA양성후조기간예치료적림상효과.방법 채용면역형광액상심편(Luminex)단항원주기술동태감측64례친속활체공신이식수자이식전후적DSA정황,대DSA양성수자급여대제량정맥주사면역구단백(WIG)화증가마체맥고분지(MMF)제량적간예치료,병분석DSA대이식신공능적영향.결과 64례수자술전검측DSA균위음성.술후감측발현10례DSA양성.DSA양성수자균위공、수자HLA항원착배적수자.10례DSA양성수자경간예치료후,기중2례DSA전음,6례DSA면역형광강도하강초과50％,2례DSA무명현하강.2례간예치료무효적수자재3～6개월후출현항체개도적배척반응도치이식신공능손해.결론 응용단항원주기술동태감측DSA적효과교호,조기응용대제량IVIG화증가MMF제량적간예치료가유효감소수자체내적DSA.
Objective To analyze the clinical application of HLA donor specific antibodies (DSAs) detected by Luminex single antigen beads,and to discuss the impact of early intervention on renal function.Method In 64 cases of living-relative renal transplantation,DSA was detected using a Luminex single antigen assay before and after transplantation.The positive recipients were given large doses of intravenous irnmunoglobulin (IVIG) and increased doses of mycophenolate mofetil (MMF).The relationship between DSA and renal function was analyzed.Result DSA was negative in all recipients before transplantation.Ten cases of DSA positive recipients were found in HLA mismatch after transplantation.After the intervention,two cases of DSA positive recipients became negative,immunofluorescence intensity was decreased by more than 50％ in 6 cases,and no significant reduction was found in the other two cases.Antibody-mediated rejection (AMR) occurred in two cases of intervention ineffective recipients after 3 to 6 months and the renal function was impaired.Conclusion Dynamic monitoring of DSA using Luminex single antigen beads may timely predict changes of renal function.Early application of large doses of IVIG and increasing doses of MMF can reduce the incidence of AMR.