肾移植术后监测受者抗HLA抗体的临床意义  

Clinical significance of monitoring of anti-HLA antibodies in kidney recipients after renal transplantation

作　　者：王庆华[1] 原欣翔[1] 唐敏英[1] 王瑾[1] 陈锦华[1] 吴琳[1] 尚乐乐[1] 谭建明[1] 

机构地区：[1]南京军区福州总医院泌尿科,福州350025

出　　处：《中华器官移植杂志》2011年第2期115-117,共3页Chinese Journal of Organ Transplantation

基　　金：基金项目：福建省移植生物学重点实验室资助（2008J1006）

摘　　要：目的监测肾移植受者术后抗HLA抗体水平，探讨新生的抗HLA抗体对移植肾功能的影响。方法共有384例肾移植受者术后进行了抗HLA抗体的监测，监测时间3～96个月，所有受者术前的抗HLA抗体水平均为阴性。使用莱姆德抗原板，采用酶联免疫吸附法（EUSA）检测抗HLA抗体，抗HLA抗体水平〉10％为阳性。对术后抗HLA抗体阳性者与阴性者间移植肾功能进行比较，观察新生抗HLA抗体对移植肾功能的影响。结果术后抗HLA抗体阴性者318例（82．8％）；阳性者66例（17．2％），其中抗HLAI类抗体阳性者3例，抗HLAII类抗体阳性者61例，抗HLAI类和Ⅱ类抗体均为阳性者2例。HLA-DR位点0个抗原错配者92例受者中有7例新生抗HLA抗体，1～2个抗原错配者292例中有59例新生抗HLA抗体，二者比较，差异有统计学意义（P〈（1．01）。术后抗HLA抗体阴性者中移植肾功能良好者占87．4％（278／318），抗HLA抗体阳性者中移植肾功能良好者占65．2％（43／66）。二者比较，差异有统计学意义（P〈0．05）。结论HLA-DR位点的抗原错配与肾移植后抗HLA抗体的产生密切相关，而新生抗HLA抗体会造成移植。肾功能下降，从而降低移植存活率，肾移植术后监测抗HLA抗体有一定的临床意义。Objective To detect de novo development of anti-HLA antibodies after renal transplantation, and to investigate their influence on graft function. Methods 384 kidney recipients, who were negative for anti-HLA antibody before transplantation, were monitored for anti-HLA antibodies over a period of 3-96 months, and a sensitive enzyme-linked immunosorbent assay （ELISA） was used to detect anti-HLA antibodies. HLA antibody 〉10% was defined as positive levels. Results Among 384 recipients tested, 318 recipients （82. 8 %） were negative for anti-HLA antibody after transplantation; 66 recipients （17. 2 0%） developed de novo HLA antibodies, 3 recipients with HLA class I, 61 with HLA class II, 2 with both HLA class I and II. According to amino acid residue matching, 7 cases developed de novo antibodies among 92 recipients with 0 HI.A-DR mismatches, compared with 59 cases among 292 recipients with 1-2 mismatches, which showed significant difference between two groups （P〈0. 01）. 87. 4 % （278/318） recipients negative for HLA antibodies after transplantation achieved good graft function, in comparison with 65.2 % （43/66） recipients positive for HLA antibodies （P〈0. 115）. Conclusion De novo production of HLA antibodies post- transplantation may be closely associated with HLA-DR mismatch. De novo HLA antibodies post- transplantation might damage graft function and reduce graft survival rate. The detection of de novo development of anti-HLA antibodies after renal transplantation has clinical significance for assessing renal allograft function.

关 键 词：肾移植 抗HLA抗体 存活率 HLA-DR抗原 

分 类 号：R699.2[医药卫生—泌尿科学]