肾移植长期存活受者致敏状态的检测及其临床意义  

Detection of sensitization to HLA antigens in long term renal transplant recipients and its clinical implication

作　　者：肖家全[1] 唐孝达[1] 王祥慧[1] 徐达[1] 周佩军[1] 丁言德[1] 沈瑾[1] 

机构地区：[1]上海市第一人民医院泌尿外科肾脏移植中心,200080

出　　处：《中华器官移植杂志》2000年第3期134-136,共3页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金资助项目 !( 39870 70 6)

摘　　要：目的　检测肾移植长期存活受者的致敏状态 ,并分析其与移植肾功能的关系。方法　在定期随访的肾移植受者中 ,选取存活 3年以上的受者 6 6例 ,其中肾功能正常者 46例 ,慢性肾功能减退者 2 0例 ,用LambdaAntigenTray(LAT)酶联免疫试剂盒检测血清中的可溶性抗HLA抗体 ,分析抗体的类型和特异性、致敏与肾功能及移植后时间的关系。结果　肾功能正常组轻度、中度、高度致敏分别为 9例、0例、2例 ,肾功能减退组为 3例、1例、4例 ;移植后 3～ 5年、6～ 8年及 8年以上的致敏率没有差异 ;致敏类型 :肾功能正常组Ⅰ类抗原致敏 0例、Ⅱ类抗原致敏 8例、Ⅰ、Ⅱ类抗原同时致敏 3例 ,肾功能减退组分别为 1例、2例、5例。结论　致敏率与移植后的时间长短无关 ;HLAⅡ类抗原是致敏的主要原因 ;移植肾功能受损与高度致敏和Ⅰ。Objectives To investigate the sensitization to HLA antigens in long term renal transplant recipients and analyze the relationship between sensitization and allograft function. Methods Among the 66 recipients surviving more than 3 years, 46 patients had normal renal function and 20 had chronic allograft dysfunction.The serum soluble HLA IgG antibodies were detected by using LAT ELISA kit.The specificity and type of antibodies were determined by using LAT software and relationship between sensitization and renal function and the posttransplant duration analyzed. Results Mild sensitization, moderate sensitization and strong sensitization were found in 9 cases, 0 and 2 in normal allograft function group, and 3, 1 and 4 in chronic allograft dysfunction group, respectively. Eight cases were sensitized by HLA class II antigen, 3 cases by both class I and II, nobody was sensitized by class I in normal allograft function group. In chronic allograft dysfunction group, one case was sensitized by class I antigen, 2 by class II, 5 by both class I and II. Sensitization rate in different posttransplant intervals had no significant difference. Conclusions Sensitization rate has no relevance to posttransplant intervals. HLA class II antigens take main responsibility for sensitization. Strong sensitization and sensitization by both class I and II antigens at the same time are detrimental to the allograft damage.

关 键 词：肾移植 免疫学 HLA抗原 抗体生成 

分 类 号：R699.2[医药卫生—泌尿科学]