供者特异性HLA抗体结合Clq与移植肾抗体介导排斥反应相关性分析  

Correlation of Clq-banding donor-specific HLA antibodies and antibody-mediated rejection after kidney transplantation

作　　者：傅茜[1] 王长希[1] 何润钧 刘龙山[1] 李军[1] 黄俊琪[1] 邓素雄[1] 费继光[1] 邱江[1] 陈国栋[1] 黄刚[1] 陈立中[1] 

机构地区：[1]中山大学附属第一医院器官移植中心广东省器官捐献与移植免疫重点实验室,广州510080

出　　处：《中华器官移植杂志》2016年第7期396-400,共5页Chinese Journal of Organ Transplantation

基　　金：广东省自然科学基金（$2013040012588）;广东省科技计划项目（2014A020212708、201480202120060）;广东省重点实验室基金项目（2013A061401007）;广州市科技计划项目（2014Y2-00114）;国家自然科学基金（81270836）

摘　　要：目的供者特异性HLA抗体（DSA）介导的排斥反应是导致慢性移植肾功能丧失的重要因素，补体的激活在抗体介导的排斥反应中起着关键作用。本研究旨在分析Clq结合型新生DSA与肾移植术后抗体介导排斥反应的相关性。方法2014年2月至2015年5月，随诊的肾移植受者经筛查、确认后，有51例受者术后有新生DSA。检测DSA及其结合Clq的能力，同时进行移植肾穿刺病理检查。分析DSA特异性、平均荧光强度（MFI）、DSA结合Clq的情况及移植肾管周毛细血管CAd沉积和组织病理表现，评估Clq结合型DSA与抗体介导排斥反应的相关性。结果51例受者中每例产生新生供者特异性抗体（dnDSA）的数目为1～4个，多数为HLA-Ⅱ类抗体，抗体MFI值为（11240±5211），MFI范围为1323～23817，病理诊断为抗体介导的排斥反应45例（88．2％，45／51）。根据DSA的Clq结合检测结果，51例受者被分为两个组，Clq阳性DSA组与Clq阴性DSA组。Clq阳性DSA组中抗体介导排斥反应的发生率为96．4％，显著高于Clq阴性DSA组（78．3％），两组差异具有统计学意义（P〈0．05）。Clq阳性DSA组移植肾微血管炎和小管间质炎的发生率分别为96．4％、64．3％，分别显著高于Clq阴性DSA组（78．3％、39．1％），差异具有统计学意义（P〈0．05）。Clq阳性DSA组移植肾管周毛细血管CAd沉积的阳性率为78．6％，与Clq阴性DSA组的阳性率（47．8％）相比，差异有统计学意义（P〈0．05）。两组的dnDSA-MFI值、移植肾功能及尿蛋白定量均无显著差异。结论Clq结合型DSA与肾移植术后抗体介导的排斥反应有较强的相关性，DSA结合Clq的检测无创伤，敏感性高，便于临床开展。Objective Donor-specific HLA （DSA） antibodies-mediated rejection is one of the important factors leading to chronic renal allograft loss. The activation of complement plays a key role in the antibody-mediated rejection （AMR）. This study aims to analyze the correlation of Clcl-binding DSA and AMR after kidney transplantation. Methods From February 2014 to May 2015, kidney transplant recipients followed-up in our hospital were screened for the HLA antibodies. There were 51 patients who were confirmed de novo DSA post-transplantation. They were detected for the Clq- binding capacity of DSA and received graft biopsy simultaneously. The specificity and mean fluorescence intensity （MFI） of DSA, DSA Clq-binding capacity, and CAd deposition in graft peritubular capillary and graft injury phenotype were assessed. Results The number of DSA was 1-4 in each 6f 51 recipients. Most of the DSA were HLA class II antibodies. DSA MFI value was 11 240 ± 5 211 （1 323-23 817）. Forty-five cases （88. 2%, 45/51） were diagnosed as biopsied proven AMP,. The recipients were divided into two groups according to DSA Clq-binding capacity（Clq ＋/-）. Group Clq（ ＋ ） had the higher rate of BPAMR, than group Clq（ - ）（96.4% vs. 78. 3%, P〈0. 05）. More graft histopathological manifestations such as microvascular inflammation, tubular and interstitial inflammation were observed in group Clq（ ＋ ）than in group Clq（ - ） （96.4%, 64. 3% vs. 78. 3%, 39. 1%, P〈0. 05）. Group Clq（ ＋ ）had more CAd deposition in peritubular capillary （78. 6% vs. 47. 8% ,P〈0. 05）. There were no significant differences in the dnDSA-MFI values, renal function and urinary protein between the two groups. Conclusion The Clq-binding DSA was correlated well to BPAMR. The examination of DSA Clq-binding capacity was noninvasive, and was easy in clinical application.

关 键 词：C1Q 供者特异性抗体 抗体介导排斥反应 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]