肾移植术后血清抗MICA抗体与慢性排斥反应的相关性  

Correlation between serum anti-MICA antibodies and chronic rejection in renal transplant recipients

作　　者：于立新[1] 叶俊生[1] 肖露露[2] 王国保[3] 邓文锋[1] 苗芸[1] 

机构地区：[1]南方医科大学南方医院器官移植科,广州510515 [2]南方医科大学南方医院组织配型中心,广州510515 [3]南方医科大学南方医院肾内科,广州510515

出　　处：《中华器官移植杂志》2010年第6期340-342,共3页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨肾移植受者的抗MICA抗体水平与慢性排斥反应的相关性及其对移植肾功能的影响.方法 共有105例受者被作为研究对象纳入分析,其中发生慢性排斥反应者（慢排组）43例,移植肾功能正常者（对照组）62例.记录两组受者术前群体反应性抗体（PRA）、HLA抗原错配数、供肾冷缺血时间、出院时血清肌酐（SCr）水平、术后免疫抑制方案以及入组时间（入组时距肾移植手术时间）等资料,并进行比较.受者分组后,抽取受者外周血,检测SCr及抗MICA抗体水平,抗MICA抗体的检测采用Luminex 100免疫磁珠流式细胞仪技术.观察与比较抗MICA抗体阳性受者和抗MICA抗体阴性受者间术后3个月内发生急性排斥反应（AR）的次数和移植肾功能的差异.移植肾功能的评价采用血清肌酐变化率（△SCr/M）,即（入组时SCr值-出院时SCr值）/入组时间.结果 两组受者在性别、年龄、HLA抗原错配数、供肾冷缺血时间、术后免疫抑制方案、出院时SCr水平及入组时间的比较,差异均无统计学意义（P＞0.05）.分组后,慢排组受者SCr水平和抗MICA抗体阳性受者比例均明显高于对照组,两组比较,差别均有统计学意义（P＜0.01,表1）.抗MICA抗体阳性受者术后3个月内发生的AR次数明显多于抗MICA抗体阴性受者,二者比较,差异有统计学意义（P＜0.05）.抗MICA抗体阳性受者的△SCr/M为8.3±3.6,明显高于抗MICA抗体阴性受者的2.4±2.6,二者比较,差异有统计学意义（P＜0.05）.结论 抗MICA抗体的表达与慢性排斥反应的发生相关,移植前进行MICA配型可减少术后移植肾慢性排斥反应的发生,有助于延长移植肾的长期存活.Objective To explore the relationship of serum anti-MICA antibody and development of chronic rejection （CR） after renal transplantation. Methods The enrolled 105 patients included 43 cases of CR, and 62 cases of functioning renal allograft as controls. Data including PRA level before transplantation, HLA mismatch, cold ischemic time, SCr at discharge, immunosuppressive regimen,and months after transplantation were analyzed. Blood samples were collected immediately after grouping for anti-MICA antibodies, SCr determination. Acute rejection episodes and renal allograft function which was evaluated by △SCr/M [（SCr at present - SCr at discharge） /months after transplantation） were compared between anti-MICA-antibody positive patients and anti-MICA-antibody negative patients. Results There was no significant difference in gender, age, HLA mismatch, cold ischemic time, immunosuppressive regimen, SCr at discharge, months after transplantation between CR and control groups （P＞0.05）. Serum creatinine level and number of antiMICA-antibody positive patients in CR group were significantly increased as compared with those in control group （P＜0.01 ）. Acute rejection episodes during the first 3 months after transplantation in anti-MICA-antibody positive patients were significantly more than those in anti-MICA-antibody negative patients （P＜0.05）,and the △SCr/M in the former was higher than that in the latter （8.3 ＋3.6 vs 2.4 ± 2.6, P＜0.05）. Conclusion Humoral immunoreaction mediated by MICA partly participates the development of CR after renal transplantation. MICA antibody is a risk factor affecting long-term allograft function.

关 键 词：肾移植 MICA抗体 慢性排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]