肾移植供者抗人类白细胞抗原抗体特异性判别中两个常见问题的探讨  

Discussion on two common problems in renal transplantation donor-specificity discrimination of anti-human leukocyte antigen antibody

作　　者：郝美杰 马立平 陈慧俊 李烟花 张雷 Hao Meijie;Ma Liping;Chen Huijun;Li Yanhua;Zhang Lei(Department of Organ Transplantation,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Suzhou Caibo Medical Research Institute,Suzhou 215000,China;Department of Nursing,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长海医院器官移植科,上海200433 [2]苏州才博医学研究所,苏州215000 [3]海军军医大学附属长海医院护理部,上海200433

出　　处：《中华医学杂志》2023年第20期1571-1574,共4页National Medical Journal of China

摘　　要：抗体介导排斥反应(AMR)是影响移植肾长期存活的关键因素,供者特异性抗体(DSA)是AMR的病因,其准确判定至关重要。目前临床广泛应用的单抗原微珠法(SAB)判别DSA时容易出现漏检以及平均荧光强度(MFI)值低估两个问题。本文通过与中国人群常见人类白细胞抗原(HLA)等位基因进行比对,计算了常用的两种SAB试剂的漏检概率,探讨了体外实验体系中抗体交叉反应对DSA的MFI值的影响。笔者提出应重视上述两个问题的临床意义,尝试用功能性表位(eplet)分析的方法予以校正并列举了临床实例,最后分析了这种校正方法的局限性。Antibody-mediated rejection(AMR)is a key factor affecting the long-term survival of renal allografts.Donor-specific antibody(DSA)is the etiology of AMR.So it is very important to accurately detect DSA.The single antigen bead(SAB)method,which is widely used in clinical practice,is prone to miss DSA detection and underestimate its mean fluorescence intensity(MFI).In this paper,the probability of missed detection of two SAB reagents was calculated by comparing common HLA alleles in China population,and the in vitro effect of antibody cross reaction on MFI value of DSA was revealed.The authors emphasized the clinical significance of the above two problems,tried to manage them by using functional epitope(eplet)analysis and give some clinical examples.Finally,the limitations of this correction method were analyzed.

关 键 词：肾移植 抗体介导的排斥反应 供者特异性抗体 人类白细胞抗原 功能性表位 

分 类 号：R699.2[医药卫生—泌尿科学]