45例再次肾移植患者HLA、PRA与移植肾功能关系的研究  

Study of Relationship between HLA,PRA and Renal Function in 45 Retransplant Patients

作　　者：贾保祥[1] 林俊[1] 苏建荣[1] 马威然[1] 田野[1] 

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《临床输血与检验》2013年第1期19-22,共4页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：北京友谊医院科研启动基金(No.2009-24)资助

摘　　要：目的研究再次肾移植患者的人类白细胞抗原(HLA)、群体反应性抗体(PRA)与肾移植术后移植肾功能的关系。方法追踪2000年3月～2010年10月收治的再次肾移植患者45例,于近期再次检测PRA及血肌酐、尿素氮浓度。PRA检测采用酶联免疫吸附法,血肌酐和尿素氮检测数据由检验科提供。结果 (1)移植肾存活5年以上组患者13例,HLA-A、B、DR和DQ抗原错配2个抗原4例,肾功能正常,PRA阴性。错配3个抗原的1例,肾功能丧失,PRA阳性;错配4个抗原的8例,PRA阴性,肾功能正常。(2)移植肾存活5年以下组患者32例:HLA-A、B、DR和DQ抗原错配1～2个抗原10例,其中8例PRA阴性,肾功能正常;2例PRA阳性,肾功能下降。HLA-A、B、DR和DQ抗原错配3个抗原患者3例,其中2例PRA阴性,肾功能正常;1例患者PRA阳性,肾功能下降。HLA-A、B、DR和DQ抗原错配4个抗原患者9例,肾功能正常5例,PRA阴性;4例患者肾功能异常,其中2例PRA阳性。HLA-A、B、DR和DQ抗原错配5个抗原7例,4例患者肾功能正常,PRA阴性;1例患者目前肾功能下降,PRA阳性。HLA-A、B、DR和DQ抗原错配6个抗原患者3例,目前肾功能正常2例,1例已丧失肾功能。结论 HLA配型是维系移植肾长期存活的重要因素,但抗-HLA对移植肾长期存活和移植肾功能的影响更重要。Objective To study relationship between HLA,PRA and renal function in 45 retransplant patients.Methods PRA, serum creatinine and urea nitrogen were retested in 45 patients who received renal retransplant from March, 2000 to October, 2010. PRA were detected by enzyme-linked immunosorbent assay （ELISA）. Serum creatinine level and urea nitrogen concentration were offered by clinical laboratory. Results Patients were classified into 2 groups according to the transplant time. （1） 13 patients with allograft survived more than 5 years： 4 patients with 2 antigens mismatching in HLA-A,B,DR and DQ, and normal renal function,negative PRA. 1 patient with 3 antigens mismatching, and impaired renal function,positive PRA. 8 patients with 4 antigens mismatching, however,normal renal function. （2） 32 patients with allograft survived less than 5 years： 10 patients with 1-2 antigens muismatching in HLA-A,B,DR and DQ, in which 8 patients with normal renal function, negative PRA and 2 patients with decreased renal function,positive PRA. 3 patients with 3 antigens mismatching, in which 2 patients with normal renal function,negative PRA and 1 patient with decreased renal function,positive PRA. 9 patients with 4 antigens mismatching, in which 5 patients with normal renal function, negative PRA. 4 patients with abnormal renal function, in which 2 patients showed positive PRA. 7 patients with 5 antigens mismatching, in which 4 patients with normal renal function, negative PRA, 1 patient with decreased renal function recently, positive PRA. 3 patients with 6 antigens mismatching, in which 2 patients with normal renal function, 1 patient with lost renal function and positive PRA. Conclusion HLA match is an important factor which can ensure long-term renal survival, but anti-HLA antibody plays a more significant role in long-term renal survival and function.

关 键 词：再次肾移植 人类白细胞抗原 群体反应性抗体 肾功能 

分 类 号：R617[医药卫生—外科学] R446.11[医药卫生—临床医学]