肾移植术后急性体液性排斥反应的监测及其临床意义  

Significance of monitoring acute humoral rejection after renal transplantation

作　　者：李留洋[1] 陈剑荣[1] 钱俊[1] 李民[1] 郭颖[1] 刘永光[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,广州510282

出　　处：《中华器官移植杂志》2012年第3期141-144,共4页Chinese Journal of Organ Transplantation

基　　金：广东省自然科学基金项目（06024438）

摘　　要：目的探讨肾移植后发生急性体液性排斥反应（AHR）的可能机制，及其在临床早期诊断和防治AHR中的重要意义。方法回顾分析2006年1月至2010年12月间296例肾移植受者的临床资料。肾移植术后，采用酶联免疫吸附试验（ELISA）动态监测受者群体反应性抗体（PRA）和供者特异性抗体（DSA）水平，采用免疫组织化学法和HE染色检查移植肾组织的病理形态学改变及CAd的沉积、浸润淋巴细胞表面分子标记。AHR诊断标准参照Banff2005标准，并结合受者的临床相关指标。结果296例受者中，术后共有25例发生了AHR，发生率为8．4％（25／296）。术前PRA阳性者和阴性者术后AHR的发生率分别为23．1％（6／26）和7．0％（19／270），两者比较，差异有统计学意义（P〈0．01）。术后发生AHR和未发生AHR受者的DSA阳性率分别为88．0％（22／25）和0．4％（1／271），出现CAd沉积阳性率分别为80．0％（20／25）和6．7％（4／60），两者间DSA阳性率和C4d沉积阳性率的比较，差异均有统计学意义（P〈0.01）。通过调整免疫抑制方案和（或）应用静脉注射免疫球蛋白、血浆置换、抗胸腺细胞球蛋白及利妥昔单抗等治疗后，19例AHR被逆转，其余6例因治疗无效，发生移植肾破裂，导致移植肾被切除。结论PRA和DSA在。肾移植术后AHR的发生中起重要作用，术后应立即开始监测PRA和DSA，以达到预防、早期诊断和合理治疗AHR的目的，进而改善移植肾的存活。Objective To investigate the possible mechanisms of acute humoral rejection （AHR） after renal transplantation and the significance of early diagnosis and prevention. Methods The clinical data of 296 cases receiving renal transplantations from January 2006 to December 2010 were retrospectively analyzed. After renal transplantation, the dynamic changes of panel reactive antibodies （PRA） and donor specific antibodies （DSA） in peripheral blood were monitored by using ELISA, and CAd deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by using immunohistochemistry. The AHR was diagnosed according to Banff 2005 criteria and clinical related indexes. Results Among 296 patients, 25 were diagnosed as AHR after transplantation with the incidence being 8.4% （25/296）. The AHR incidence after transplantation in patients positive and negative for PRA before transplantation was 23. 1 ~///00 （6/26） and 7. 0~ （19/270） respectively （P^0. 01）. The DSA positive rate in the recipients with AHR and without AHR after transplantation was 80. 0~ （20/25） and 6. 70/00 （4/60） respectively. There was significant difference in DSA and CAd positive rate between AHR and non-AHR patients （P^0. 001）. By adjusting several therapies, such as the immunosuppressive program and （or） application of intravenous immunoglobulin, plasmapheresis, antithymocyte globulin and rituximab monoclonal antibody, 19 cases of AHR were reversed, and the remaining 6 cases had rupture of renal allograft due to ineffective treatment, leading to the removal of the transplanted kidney. Conclusion PRA and DSA were important for AHR after renal transplantation. Immediately monitoring of the PRA and DSA after transplantation is recommended in order to achieve the purposes of prevention, early diagnosis and rational treatment for AHR, thus improving the survival of the transplanted kidney.

关 键 词：肾移植 移植物排斥 抗体 监测 免疫学 

分 类 号：R699.2[医药卫生—泌尿科学]