肾移植术前供者特异性抗体强度对术后的体液排斥反应和移植物功能的影响  

Effect of pre-transplant donor specific antibody on antibody-mediated rejection and graft dysfunction

作　　者：王宁[1] 李卫[1] 张盛[1] 

机构地区：[1]中南大学湘雅三医院移植外科,长沙410013

出　　处：《中南大学学报（医学版）》2016年第5期513-519,共7页Journal of Central South University ：Medical Science

基　　金：湖南省科学技术厅科技计划一般项目(2013SK3063)~~

摘　　要：目的:研究肾移植受者的术前供者特异性抗体(donor specific antibody,DSA)与其术后发生抗体介导的体液排斥反应(antibody-mediated rejection,AMR)及移植肾功能的关系。方法:选取符合要求的肾移植受者88例。术前采用Luminex流式法对肾移植受者进行DSA检测,并将受者分为DSA阳性组(n=20)与DSA阴性组(n=68)。随访时间为2年。术后参照Banff 2005标准对移植肾病理形态进行评估分级,并观察移植肾的情况。结果:DSA阳性组与阴性组AMR发生率分别为20.0%和1.5%,移植物丢失发生率分别为15.0%和1.5%,两组比较差异均有统计学意义(分别P<0.01,P<0.05);AMR受者最高DSA的荧光指数中值(mean fluorescence intensity,MFI)较非AMR受者差异明显(P<0.01);受试者工作特征(receiver operating characteristic,ROC)曲线显示肾移植术后受者发展为AMR的最高MFI阈值为7909.5。两组移植肾功能延迟回复的发生相比较,差异无统计学意义(P>0.05)。结论:肾移植术前检测DSA水平,可以预测AMR的发生风险和移植肾功能状态。最高DSA值的MFI截点(7909.5)能够预测AMR发生的风险。Objective：To explore the effect of pre-transplant donor specific antibody（DSA） on antibodymediated rejection（AMR） and function of transplanted kidney.Methods：A total of 88 cases of renal transplant recipients were selected.Before surgery,DSA was examined by Luminex liquid phase chip in renal transplant recipients.The recipients were divided into a DSA positive group（n=20） and a DSA negative group（n=68）.The follow-up time was 2years.After the operation,the pathologic morphology of the transplanted kidney was evaluated and classified according to the Banff 2005 standard.The situation for the transplanted kidney was evaluated.Results：The incidence of AMR in the DSA positive group and negative group was 20%and1.5%,respectively,with significant difference between them（P〈0.0l）.The incidence of graft loss in the DSA positive group and negative group was 15%and 1.5%,respectively,with significant difference between them（P〈0.05）.The pre-transplant DSA associated with AMR at multiple mean fluorescence intensity（MFl） was obvious different from that without AMR（P〈0.0l）.Receiver operating characteristic（ROC） curves showed that the maximal MFI threshold for recipients with AMR was 7909.5 after renal transplantation.There was no significant difference in the delayed recovery of renal graft function（DGF） between the 2 groups（P〈0.05）.Conclusion：The detection of DSA level before renal transplantation can predict the risk of AMR and the function of transplanted kidney.The MFI intercept point of the highest DSA（MFI7909.5） can be used to predict the risk of AMR.

关 键 词：供者特异性抗体 抗体介导的体液排斥反应 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]