高龄肾移植患者抗HLA抗体和MICA抗体对肾功能的影响  

Influence of HLA and MICA Antibodies on Renal Function in Old Recipients

作　　者：贾保祥[1] 武俊杰[1] 徐秀红[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿科,北京100050

出　　处：《临床输血与检验》2014年第4期358-361,共4页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的分析年龄大于60岁的肾移植患者术后PRA和MICA抗体对移植肾功能的影响。方法选择>60岁的高龄肾移植患者179例,对血清标本进行PRA和MICA抗体检测,并观察移植肾功能。结果 179例高龄肾移植患者中,抗体阳性患者32例(17.88%)。其中肾功能下降患者28例(87.5%)。抗体阴性患者147例中,肾功能下降患者7例(4.76%)。抗体阳性的肾移植患者,其移植肾功能下降率高于抗体阴性者,差异具有统计学意义(χ2=10.763,P<0.000 1)。移植肾存活大于10年以上的高龄患者91例,抗体阳性患者16例;移植肾存活未达10年以上的高龄患者88例,抗体阳性患者16例,两组患者抗体阳性率的差异无统计学意义(χ2=0.008 2,P>0.05)。移植肾存活已大于10年以上的患者中13例PRA抗体阳性,3例MICA抗体阳性,1例为抗HLA-Ⅰ+Ⅱ类和MICA阳性。16例抗体阳性患者移植肾功能均有不同程度下降。移植肾存活未达到10年的患者中15例PRA阳性,3例患者肾功能正常,为抗HLA-Ⅱ类阳性;12例患者移植肾功能均不同程度下降。结论抗HLA抗体和MICA抗体影响移植肾长期存活。肾移植术后动态监测抗HLA抗体和MICA抗体的变化,对预测移植肾排斥反应的发生、指导临床治疗、预防移植肾功能减退具有重要意义。Objective To study the influence of HLA and MICA antibodies on graft function in old （over age of 60 years） recipients. Methods One hundred and nine recipients were selected, HLA and MICA antibodies were tested,and the renal function was examined. Results Thirty two of 179 recipients showed positive antibodies （17.88%）. Among them, 4 cases had normal renal function（12.5%）. Seven case（4.76%） were found to have injured renal founction in 147 patients with negative antibodies against HLA and MICA. Severer injuries of renal function were noted in the pathients who had positive antibodies compared with those with negative tests （x2= 10. 763,P〈0. 000 1）. Sixteen cases with positive anti bodies in Ninety one elderly patients had as long as 10 years grafted renal survival. Among eighty eight patients with less than 10 years renal survival, 16 had positive antibodies, showing a significant difference （x2= O. 008 2,P〉0.05）. However, in 13 patients with over 10 years renal survival, 3 demonstrated positive MICA,and 1 positive HLA I＋II and MICA. All 16 recipients in this group with significant renal function decrease. Among88 recipients with less than 10 years graft survival,16 ones showed positive antibodies, 15 showed positive PRA, 3 showed positive HLA II with normal renal function. 12 recipients had injured renal function with different degrees. There was no significant difference between the the two groups in renal survival. Conclusion HLA and MICA antibodies influence long term survival of kidney. Monitoring of HLA and MICA antibodies is of great significance in predicting renal rejection and guiding clinical treatments and protecting renal hypofunetion.

关 键 词：肾移植 高龄 HLA抗体 主要组织相容性Ⅰ类相关链A基因抗体 肾功能 

分 类 号：R318.06[医药卫生—生物医学工程]