肾移植术后新生HLA抗体和MICA抗体对移植肾功能的损伤作用  

Impact of post transplant development of HLA antibodies and MICA antibodies on renal allograft function

作　　者：彭志国[1] 田军[1] 扈煜[2] 张鲁伟[1] 崔先泉[1] 毕正[3] 鲜万华[1] 孙怀斌[1] 李恩刚[1] 

机构地区：[1]山东大学齐鲁医院血液净化肾移植科,济南250012 [2]山东大学齐鲁医院血液科,济南250012 [3]山东大学齐鲁医院检验科,济南250012

出　　处：《山东大学学报（医学版）》2009年第12期74-77,共4页Journal of Shandong University:Health Sciences

摘　　要：目的研究肾移植术后新生人类白细胞抗原(HLA)抗体及主要组织相容性I类相关链A抗原(MICA)抗体的产生对移植肾功能的损伤作用。方法采用免疫磁珠流式细胞仪液相芯片技术检测96例肾移植患者HLA及MICA抗体。根据检测结果,将患者分为HLA抗体阳性组(HLA+)、MICA抗体阳性组(MICA+)、以及HLA、MICA抗体阴性组(HLA-/MICA-),观察并比较各组不良免疫事件的发生率。再根据有无急性排斥(AR),将患者分为排斥组(AR+)和非排斥(AR-)组,观察HLA抗体、MICA抗体对移植肾功能的影响。结果HLA+组急性排斥反应发生率高于HLA-/MICA-组(43.5%vs11.7%,P<0.05);MICA+组急性排斥反应发生率与HLA-/MICA-组比较差异无统计学意义(15.3%vs11.7%,P>0.05);AR+组中,HLA+患者术后1、3、6和12个月时血清肌酐水平高于HLA-/MICA-患者,MICA+患者在术后1、3月时血肌酐水平高于抗体阴性患者;AR-组中,HLA+患者术后6、12个月血肌酐水平高于HLA-/MICA-患者;MICA+组在术后6个月及12个月的尿蛋白定量均值高于150mg,并随时间逐渐升高。结论HLA抗体对移植肾功能的损伤作用表现为血清肌酐的升高以及与急性排斥反应的发生有关;MICA抗体对移植肾功能的损伤主要表现为尿蛋白定量的升高。Objective To study the impact of post transplant development of human leucocyte antigen（HLA）antibodies and MHC class I chain-related A antigen（MICA）antibodies on renal allograft function.Methods Post transplant sera of 96 renal transplantation patients were tested by Luminex flow cytometry for HLA antibodies and MICA antibodies.According to the test results,patients were divided into the HLA antibodies-positive（HLA＋）group,MICA antibodies-positive（MICA＋）group,and HLA antibodies and MICA antibodies-negative（HLA-/MICA-）group.The incidence of adverse immune events was compared among these groups.According to having acute rejection（AR）or not,patients were divided into the AR＋group and AR-group,and the impacts of HLA antibodies and MICA antibodies on renal graft function were observed.Results The AR incidence in the HLA＋ group was higher than in the HLA-/MICA-groups（43.5% vs 11.7%,P〈0.05）.There was no statistical significance in the AR episodes between the MICA＋ group and the HLA-/MICA-groups（15.3% vs 11.7%,P〉0.05）.Higher serum creatinine levels in the 1st,3rd,6th and 12th months after transplantation were evidenced in the HLA＋ group with more AR episodes than in those who had AR but did not produce antibodies.In the MICA＋ group with AR,the serum creatininelevels in the 1st and 3rd months after transplantation were higher than in patients with AR but without antibodies.Urine protein quantitation in the MICA＋ group in the 6th and 12th months after transplantation exceeded 150 mg and increased with time.Conclusion HLA antibodies play an important role in AR episodes after kidney transplantation and the renal allograft function could be damaged by HLA antibodies.MICA antibodies may result in an increase in urine protein quantitation for the kidney recipient and may damage renal allograft function.

关 键 词：肾移植 HLA抗体 MICA抗体 移植物排斥 

分 类 号：R392[医药卫生—免疫学]