C1q结合的供者特异性抗体预测高致敏患者肾移植后抗体介导的排斥反应  

Clq-flxing donor specific antibody predicting antibody-mediated rejection early after transplantation in sensitized renal transplantation patients

作　　者：赵杰[1] 宋文利[1] 莫春柏[1] 王智平[1] 付迎欣[1] 郑建明[1] 冯刚[1] 杨涛[1] 吴长利[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院天津市器官移植重点实验室,300192

出　　处：《中华器官移植杂志》2014年第11期668-671,共4页Chinese Journal of Organ Transplantation

基　　金：天津市卫生局科技基金（2013KY08）;公益性行业科研专项（201302009）

摘　　要：目的探讨术前C1q结合的供者特异性抗体（C1q^＋DSA）预测高致敏肾移植受者术后早期抗体介导排斥反应（AMR）的价值。方法回顾性分析2012年1月至2014年1月30例术前存在高致敏状态的肾移植受者的临床资料，采用单抗原磁珠法检测受者术前的供者特异性抗体（DSA）和C1q^＋DSA，并分析术前DSA和C1q^＋DSA与术后早期AMR的关系。结果术前DSA阳性者22例，其中12例为C1q^＋DSA，10例发生AMR（包括3例超急性排斥反应）。术前DSA预测术后发生AMR的敏感性100％，特异性为40％，阳性预测值为45．5％，阴性预测值为100％；C1q^＋DSA预测AMR的敏感性为100％，特异性为90％，阳性预测值为83．3％，阴性预测值100％。与DSA预测AMR相比，C1q^＋DSA的特异性和阳性预测值均显著升高（P〈0．01，P〈0．05）。结论C1q^＋DSA可以预测术后早期AMR的发生，术前区分补体结合的DSA和非补体结合的DSA，避开C1q阳性的抗HLA抗体能增加高致敏患者的移植机会，减少AMR的发生风险。Objective To investigate the-Cl-q fixing donor specific antibody （C1q^＋ DSA） predicting antibody-mediated rejection （AMR） early after transplantation in sensitized renal transplantation patients. Method DSA and C1q^＋ DSA were retrospectively analyzed in 30 highly sensitized renal transplant patients using a Luminex platform from Jan. 2012 to Jan. 2014 in our hospital. The relationship between preoperative C1q^＋ DSA and AMR early after transplantation was analyzed. Result DSA was detected in 20 cases before operation, C1q^＋ DSA in 12 cases, and AMR in 10 cases （including 3 cases of hyperacute rejection）. Preoperative C1q^＋ DSA had a positive predictive value （PPV） of 83.3% and a negative predictive value （NPV） of 100G, with 100% sensitivity and 90% specificity for AMR respectively. C1q^＋ DSA had higher positive predictive value （83.3% vs. 45. 5% ,P〈0. 05） and higher specificity （90% vs. 40%, P〈0. 01） than DSA for AMR. Conclusion The Clq assay can detect a sub-set of antibodies capable of fixing complement and predict AMR early after transplantation. Avoiding only the donor antigens that would be recognized by the Clq assay may accelerate time to transplantation by expansion of the donor pool and reduce AMR.

关 键 词：肾移植 供者特异性抗体 补体C1Q 抗体介导排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]