供者HLA-Cw和受者KIR基因多态性以及HLA-Cw/KIR组合型对移植肾功能的影响  

Effect of HLA-Cw /KIR gene polymorphism and HLA-Cw /KIR matching on allograft renal function

作　　者：徐小明 任雨 姚许平 夏鹏[2] 

机构地区：[1]宁波市鄞州第二医院移植科,315000 [2]温州医科大学附属第一医院移植科

出　　处：《中华移植杂志（电子版）》2014年第1期13-17,共5页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨移植肾功能与供者HLA-Cw基因型、受者KIR基因型以及HLA-Cw/KIR基因组合型的关系。方法收集2010年9月至2011年4月于温州医科大学附属第一医院接受肾移植的78例受者随访资料(随访截止时间为2013年3月)。根据随访过程中对受者移植肾功能的评估进行分组,34例受者分入移植肾功能异常组,44例受者分入移植肾功能正常组。分析两组受者临床资料,用聚合酶链反应-序列特异性引物技术检测并分析供者HLA-Cw基因和受者KIR基因多态性及HLA-Cw/KIR组合型。结果两组肾移植受者在年龄、性别、冷缺血时间、热缺血时间、HLA错配数、免疫抑制方案、发生急性排斥反应方面差异均无统计学意义(P均>0.05)。移植肾功能异常组受者相应供者HLA-C1/C1基因组合型出现频率为70.6%,高于移植肾功能正常组(40.9%),差异具有统计学意义(χ2=6.798,P<0.05);HLA-C1/C2基因组合型出现频率为23.5%,低于移植肾功能正常组(50.0%),差异具有统计学意义(χ2=5.678,P<0.05)。移植肾功能异常组受者KIR2DL2、KIR2DS2、KIR3DL1基因型出现频率分别为17.6%,17.6%,79.4%,均低于移植肾功能正常组(45.5%,43.2%,95.5%),差异均具有统计学意义(χ2=6.674,5.741和4.836,P均<0.05);KIR2DL1、KIR2DS4基因型出现频率均为97.1%,均高于移植肾功能正常组(均为79.5%),差异均具有统计学意义(χ2均=5.263,P均<0.05)。HLA-C1/C2-KIR2DL1、HLA-C1/C2-KIR2DL3组合型出现频率在移植肾功能异常组中分别为17.6%,14.7%,低于移植肾功能正常组(43.2%,38.6%),差异具有统计学意义(χ2=4.513和5.424,P均<0.05)。结论供者HLA-Cw基因型、受者KIR基因型以及供、受者间特定的HLA-Cw/KIR组合型可能对移植肾功能产生影响。Objective To explore the relationship between allograft renal function and HLA-Cw genotypes of donors, KIR genotypes of receptors, and the matching of HLA- Cw/KIR. Methods A total of 78 patients who had undergone the kidney transplantation in our hospital from September 2010 to April 2011 （follow-up until March 2013 ）, were divided into normal graft function group （44 cases） and abnormal graft function group （34 cases ）. Clinical data of all patients were retrospectively analyzed. At the same time, the HLA- Cw genes of donors and KIR genes of receptors were detected by the PCR-SSP method, and then the clinical data about transplant patients, HLA-Cw genes of donors, KIR genes of receptors and the matching of HLA-Cw/KIR were analyzed. Results Two groups ofkidney transplantation patients in age, gender, warm and cold ischemia time, mismatching of HLA-A/ B/DR, immune suppression scheme have no significant difference （P 〉 0.05, respectivety）. In the abnormal graft function group, the HLA-CI/C1 genotype frequency was high, while the HLA-CI/C2 genotype frequency was low. Compared with normal graft function group, KIR2DL2, KIR2DS2, KIR3DL1 genotypes frequency in abnormal graft function group were lower and KIP,2DL1, KIR2DS4 genotypes frequency were higher. The matching between HLA-Cw and KIR genotypes of the two groups as following： the frequency of HLA-C1/C2-KIR2DL1 and HLA-C1/C2-KIR2DL3 matching in abnormal graft function group were lower than that in normal graft function group. Conclusion The HLA- Cw of domors, KIR genotypes of receptors and the matching of HLA- Cw/KIR might influence the function of renal allograft.

关 键 词：人类白细胞抗原 杀伤细胞免疫球蛋白样受体 肾移植 移植肾功能 

分 类 号：R699.2[医药卫生—泌尿科学]