抗MICA抗体的产生途径及其对肾移植后急性排斥反应治疗效果的影响  

Anti-MICA antibodies., production path and impact on therapeutic efficacy after renal transplantationwith acute rejection

作　　者：于立新[1] 刘如敏[1] 罗敏 肖露露 付绍杰[1] 王亦斌[1] 张新科[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]解放军第四五八医院组织配型中心

出　　处：《中华器官移植杂志》2012年第6期339-342,共4页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金（81070594,81141058）;广东省科技计划（201013031600240）

摘　　要：目的探讨抗多态性主要组织相容性复合体I类相关链A（MICA）抗体的产生途径及其对肾移植后急性排斥反应（AR）治疗效果的影响。方法随机抽取等待肾移植者157例，采用Luminex200液相芯片分析技术检测抗MICA抗体及其特异性，并采集临床资料，分析抗MICA抗体的产生途径及其免疫球蛋白类型，进而探讨IgM型抗MICA抗体与IgM和IgG复合型抗MICA抗体对肾移植后急性排斥反应（AR）发生率和治疗效果的影响。结果157例中，既往有输血、妊娠、移植史者68例，移植前抗MICA抗体阳性者19例（27．9%）；既往没有致敏经历者89例，移植前抗MICA抗体阳性者26例（29．2％），二者间抗MICA抗体阳性率的差异无统计学意义（P〉O．05）。抗MICA抗体阳性者45例，其中26例（57．8％）既往无致敏经历，其抗MICA抗体类型为IgM；另19例（42．2％）有已知的一种或多种致敏经历，其抗MICA抗体类型为IgG和IgM复合型。抗MICA抗体阳性的45例，有38例接受了肾移植，其中22例IgM型抗MICA抗体者，有7例（31．8％）发生AR，经甲泼尼龙冲击治疗均获得逆转，另16例IgM和IgG复合型抗MICA抗体者亦有7例（43．8％）发生AR，经甲泼尼龙等治疗，3例（42．9％）逆转，4例移植肾功能丧失；两种免疫球蛋白类型抗MICA抗体阳性者间肾移植后AR发生率的差异无统计学意义（P〉0．05），但AR逆转率的差异有统计学意义（P〈0．05）。结论对于无致敏史者其抗MICA抗体的产生可能存在经典的“天然抗体”的产生途径，其免疫球蛋白类型为IgM，肾移植后若发生AR，治疗转归较好；而对于移植前预存IgG和IgM复合型抗MICA抗体者，因其AR治疗的转归不佳，需予以足够重视。Objective To investigate the production path of major histocompatibility complex class I chain-related gene A（MICA） antibodies and the impact on the therapeutic efficacy after acute rejection in renal transplantation recipients. Methods Luminex flow cytometry was used to detect anti- MICA antibodies and the antibody specificity in 157 pre-transplant kidney transplant recipients randomly selected. The clinical data were collected, anti-MICA antibody production pathway and immunoglobulin types were analyzed, and the impact of IgM anti-MICA antibody and IgM^IgG complex anti-MICA antibodies on acute rejection （AR） incidence and therapeutic efficacy after renal transplantation. Results Of the total 157 recipients, 19 recipients were positive for anti-MICA antibodies before renal transplantation in 68 recipients who had history of blood transfusion, pregnancy and transplant sensitized experience （27. 9%）; In 89 recipients having no sensitized experience, MICA antibodies were positive in 26 recipients （29. 2%） （P〉0. 05）. In 45 anti-MICA antibody positive recipients, the anti-MICA antibodies type was IgM in 26 cases having no sensitized experience; and that was IgG and IgM complex in 19 cases having sensitized experience. In 38 anti- MICA antibody-positive recipients undergoing kidney transplantation, 7 out of 22 IgM anti-MICA antibodies recipients had AR （31.8%） that was reversed by methylprednisolone pulse therapy, and 7 out of 16 IgM＆IgG complex anti-MICA antibodies recipients had AR （43. 8%） and treated with methylprednisolone pulse therapy： reversion in 3 recipients （42. 9%）, and the graft function loss in 4recipients. The AR incidence was not associated with the two immunoglobulin types of MICA antibodies（P〉0.05）, but there was significant difference in the reversal rate of AR （P〈0. 05）. Conclusion For non-allergenic history recipients, there exists the classic“natural antibodies” pathway in the production of the anti-MICA antibodies whose immunoglobulin type wa

关 键 词：肾移植 移植物排斥 MICA治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学]