肾移植受者人类白细胞抗原体液免疫致敏状态的监测及其临床意义(英文)  

Monitoring human leukocyte antigen humoral immunity sensitization in renal transplant recipients and its clinical significance

作　　者：李留洋[1] 刘占国 陈剑荣[1] 钱俊[1] 孙尔维[1] 赵明[1] 

机构地区：[1]南方医科大学附属珠江医院器官移植科,广东省广州市510282

出　　处：《中国组织工程研究与临床康复》2008年第18期3561-3566,共6页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:器官移植受者在受到同种抗原人类白细胞抗原(HLA)免疫致敏后,外周血中容易产生群体反应性抗体,如何提高致敏受者肾移植的成功率和移植物长期存活率值得深入研究。目的:通过检测肾移植受者的HLA-IgG抗体水平及其特异性,评估受者体液免疫致敏状态,并观察HLA交叉反应组配型可接受性错配情况与移植肾存活率的关系。设计:临床观察。单位:南方医科大学附属珠江医院。对象:选择1998-01/2005-12在南方医科大学附属珠江医院器官移植科接受肾移植1297例患者,男824例,女473例,平均(42±16)岁,其中HLA-IgG抗体阳性受者165例,阴性受者1132例。初次肾移植受者1217例,2次移植77例,3次移植2例,4次移植1例。所有患者在接受本实验相关检测及治疗前均签署知情同意书,本实验经过医院伦理委员会批准许可。试剂:莱姆德抗原板和混合抗原板购自美国One Lambda公司。HLA-Ⅰ类单克隆抗体湿板和HLA-Ⅱ类DNA分型试剂购自美国One Lambda公司;Taq多聚酶购自美国PE公司;DNA抽提试剂购自德国QIAGEN公司。抗人C4d多克隆抗体和显色底物DAB购自奥地利Biomedica公司。方法:①通过酶联免疫吸附试验筛查受者术前血清中的HLA-IgG抗体,对阳性血清进一步用抗原板(LAT1240和LAT1HDS)检测抗体阳性率及其特异性,采用序列特异性引物聚合酶链反应技术进行HLA基因分型。②对40例Scr升高的受者进行抗HLA抗体检测和移植肾穿刺活检,并通过免疫组织化学染色观察肾小管周围毛细血管壁上C4d的沉积。③移植受者术后1,3,5年移植肾存活率及性别、移植与抗体阳性率的关系,并分析不同HLA交叉反应组错配数受者移植肾存活率的差别。主要观察指标:①肾移植患者手术前后HLA-IgG抗体阳性率及HLA分型。②移植肾活检组织中肾小管周围毛细血管壁上C4d的沉积特征。③移植肾存活率差别。结果:患者1297例均进入结果分析�BACKGROUND： Panel reactive antibodies （PRA） easily appear in the peripheral blood of organ transplant recipients sensitized by allogeneic human leukocyte antigen （HLA）. How to enhance the success rate of renal transplantation and long-term survival rate of renal allografts in sensitized recipients should be further studied. OBJECTIVE： This study was to detecthuman leukocyte antigen immunoglobulin G（HLA-IgG） antibody level and its specificity in renal transplant recipients, evaluate humoral immunity sensitization, and investigate the relationship of the acceptable mismatching of HLA cross-reactive group and survival rate of renal allograft. DESIGN： A clinical observation. SETTING： Zhujiang Hospital Affiliated to Southern Medical University. PARTICIPANTS： A total of 1297 patients, 824 males and 473 females, averaging （42±16） years of age, received renal transplantation in the Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University between January 1998 and December 2005, were recruited for this study. Among these patients, 165 were HLA-IgG antibody-positive recipients, 1132 were HLA-IgG antibody-negative ones, 1217 received renal transplantation for the first time, 77 received renal transplantation twice, 2 three times, and l four times. Written informed consent was obtained from each subject for related laboratory measurements and treatment The protocol was approved by the Hospital＇s Ethics Committee. Reagents： Lambda antigen tray （LAT）, Lambda antigen tray mixed （LATM）, Special Monocloneal Tray-Asian HLA Class I, and Micro SSP？ Generic HLA Class II were purchased from One Lambda Company, USA. Taq polymerase was purchased from PE Company, USA. DNA extract reagent was from Qiagen Company, Germany. Anti-human complement 4d （C4d） polyclonal antibody and chromogenic substrate DAB were purchased from Biomedica Company, Austria. METHODS： Prior to operation, serum HLA-IgG antibody in the recipients was determined by an enzyme linked immunosorbent a

关 键 词：组织配型 体液免疫 群体反应性抗体 肾移植 

分 类 号：R617[医药卫生—外科学]