供者特异性抗体监测在肾移植中的应用  

Donor specific antibodies monitoring in the kidney transplantation

作　　者：郑瑾[1,2] 薛武军[1,2] 景鑫[1,2] 侯军[1,2] 田晓辉[1,2] 郭奇[1,2] 

机构地区：[1]西安交通大学医学院器官移植研究所 [2]西安交通大学医学院第一附属医院肾病医院肾移植科,710061

出　　处：《中华移植杂志（电子版）》2014年第3期16-20,共5页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的研究肾移植术后受者血清中供者特异性抗体(DSA)与发生急性排斥反应的关系,为临床早期诊断、合理制定个体化治疗方案、评估疗效提供客观的参考依据。方法选取2012年1月至2013年8月西安交通大学医学院第一附属医院肾病医院肾移植科285例首次肾移植受者,术后动态监测DSA水平,检测时间点为术后3,5,7,14,21,30,60,90 d。观察受者肾功能和急性排斥反应发生情况。使用卡方检验或Fisher精确概率法比较不同HLA抗体类型的受者急性排斥反应发生率。结果 285例肾移植受者术后初筛人类白细胞抗原(HLA)抗体阳性率为22.11%(63/285),其中DSA阳性4例。急性排斥反应发生率6.67%(19/285)。HLA抗体阴性受者和HLA抗体阳性且DSA阴性受者急性排斥反应发生率分别为3.15%(7/222)和16.95%(10/59),二者相比差异有统计学意义(χ2=12.891,P<0.05);4例DSA阳性受者有3例发生急性排斥反应,与HLA抗体阴性、HLA抗体阳性且DSA阴性受者急性排斥反应发生率相比,差异均有统计学意义(P=0.000和P=0.016)。19例发生急性排斥反应受者经甲泼尼龙、兔抗人胸腺细胞免疫球蛋白冲击治疗或血浆置换等治疗后,15例受者成功逆转,1例死于并发症。结论动态监测肾移植术后受者DSA水平,可预测移植肾功能状态,对急性排斥反应的发生有重要预警作用,有利于及时清除或降低DSA水平,对有效预防和及时诊治排斥反应具有重要作用。Objective To study the relationship between acute rejection and human leukocyte antigen （HLA） antibody and donor specific antibodies （DSA） in patients after kidney transplantation for clinical early diagnosis,provide objective reference for reasonable individualized treatment,and evaluate therapeutic effect.Methods A total of 285 cases of kidney transplantation patients for the first time were observed in this study.HLA antibody,DSA,renal function and rate of acute rejection occurrence were monitoring after transplant.Results The positive rate of HLA antibody was 22.11% （63 cases） and the occurrence of acute rejection was 6.67% （19 cases） in total of 285 cases of transplantation.The incidence of acute rejection was 3.15% （7/222） in HLA antibodies negative patients,and was 16.95% （10/59） in HLA antibody positive with DSA negative patients.There was a statistically significant between the two groups （x2 =12.891,P 〈 0.05）.There were 3 patients who occured acute rejection in the 4 patients with DSA positive,which was significant difference with HLA antibodies negative patients and HLA antibody positive with DSA negative patients （P =0.000 and P =0.016）.Conclusions Dynamic monitoring of HLA antibody and DSA in patients with kidney transplantation could predict the state of graft function,be beneficial to eliminate and reduce DSA,and play an important role on effective prevention and timely treatment to reject reaction.

关 键 词：肾移植 群体反应性抗体 供者特异性抗体 

分 类 号：R699.2[医药卫生—泌尿科学]