C4d联合外周血抗体对移植肾患者预后的预测价值  

Predictive value of C4d combined with HLA antibody and MⅠCA antibody on prognosis of renal transplantation patients

作　　者：张明[1] 顾勇[1] 陆福明[1] 瞿连喜 何军[3] 袁晓妮[3] ZHANG Ming;GU Yong;LU Fu-ming;QU Lian-xi;HE Jun;YUAN Xiao-ni(Department of Nephrology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Urology,Huashan Hospital,Fudan University,Shanghai 200040,China;Jiangsu Institute of Hematology,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040 [2]复旦大学附属华山医院泌尿外科,上海200040 [3]苏州大学附属第一医院,江苏省血液研究所,苏州215006

出　　处：《中国临床医学》2018年第1期56-60,共5页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨移植肾病理及预后与C4d及外周血抗体的相关性。方法:选择52例有完整病理资料的移植患者。用冰冻切片通过间接免疫荧光法进行C4d染色,采用Luminex技术检测外周血人类白细胞抗原(HLA)抗体、组织相容性复合体Ⅰ类相关链A(MⅠCA)抗体。随访1年,分析C4d与外周血抗体及移植肾病理的关系以及对移植肾功能的影响。结果:C4d阳性者HLA抗体阳性率88.9%,C4d阴性者HLA抗体阳性率40%;C4d阳性者HLA抗体阳性率高于C4d阴性者(P=0.003)。C4d阳性者肾小球炎比例较高(P=0.023);HLA抗体阳性者移植肾血管炎及动脉内膜增厚发生率较阴性者明显增高(P<0.05);MⅠCA抗体阳性、阴性移植肾病理形态差异无统计学意义。单独C4d阳性者与阴性者肾小球滤过率(GFR)差异无统计学意义;C4d伴随外周血HLA或MⅠCA抗体阳性者较单独C4d阳性者GFR下降更明显(P<0.05)。结论:对于急性排异的患者,C4d阳性伴外周血HLA或MⅠCA抗体阳性较单独C4d对移植肾预后更有预测价值。Objective:To investigate the relationships of C4d,HLA antibody,and MⅠCA antibody with renal pathology.Methods:Totally 52 patients with complete pathological data were included and followed up for one year.The C4d was stained with indirect immunofluorescence,the levels of HLA antibody and MⅠCA antibody in peripheral blood were detected by Luminex method.The relationships of C4d with antibodies in peripheral blood and pathology of renal graft were analyzed,and their influences on renal function were exposed.Results:The positive rate of HLA antibody was 88.9%in cases with positive C4d and 40%in the cases with negative C4d.The positive rate of HLA antibody was higher in patients with positive C4d than that in patients with negative C4d(P=0.003).The proportion of glomerulitis was higher in cases with positive C4d(P=0.023),and vasculitis and arterial intimal thickening of transplanted renal were more common in cases with positive HLA antibody than those with negative HLA antibody(P<0.05),while no correlations between histological features and MⅠCA antibody were found.There was no difference in glomerular filtration rate(GFR)between cases with positive and negative C4d,but in patients of positive C4d with positive HLA antibody or MⅠCA antibody,the GFR decreased more remarkably compared with those of single positive C4d(P<0.05).Conclusions:For patients of acute rejection,positive C4d combined with positive antibodies of HLA and MⅠCA in peripheral blood has better predictive value for graft survival compared with single positive C4d.

关 键 词：肾移植 HLA抗体 MⅠCA抗体 急性排异 C4D 

分 类 号：R617[医药卫生—外科学]