519例肾衰竭患者群体反应性抗体的种类与频率研究  

Study on the type and frequency of panel reactive antibody in 519 renal failure patients

作　　者：胡光磊[1] 苏蔓[1] 张泓楠 王振雷[1] 何路军[1] HU Guanglei;SU Man;ZHANG Hongnan;WANG Zhenlei;HE Lujun(Hebei Blood Center,Shijiazhuang 050071,China)

机构地区：[1]河北省血液中心

出　　处：《中国输血杂志》2019年第10期1032-1034,共3页Chinese Journal of Blood Transfusion

摘　　要：目的分析肾衰竭患者的PRA水平及抗-HLAⅠ、Ⅱ类抗体的种类与频率。方法 2010年1月-2018年4月在本配型中心做PRA检测的肾衰竭患者519名。采用美国One lambda公司ELISA抗原鉴定板(LAT-1240)检测,以HLA Fusion3.0软件分析抗体阳性率及类型。结果 519例肾衰竭患者中:PRA为0-10%轻度致敏者占26.6%(29/109);10%-50%中度致敏者占47.71%(52/109);≥50%高度致敏者占25.69%(28/109)。不同性别患者男、女的PRA致敏率分别为17.6%(72/409)和33.64%(37/110),差异具有统计学意义(P<0.01),提示女性患者较男性患者容易产生抗-HLA。所有患者中PRA阳性者共80例,占15.41%(80/519),其中抗-HLAⅠ类抗体阳性患者占8.86%(46/519);抗-HLAⅡ类抗体阳性患者占4.05%(21/519);抗-HLAⅠ+Ⅱ类抗体阳性患者占2.5%(13/519)。PRA阳性患者中:65例(包括46例HLAⅠ≥10%+13例抗-HLAⅠ+Ⅱ均≥10%+6例HLAⅡ≥10%的HLAⅠ轻度致敏者)检出HLAⅠ类抗体,包括:抗-HLA-A 19种,抗-HLA-B 21种,抗-HLA-C 4种;37例(包括21例HLAⅡ≥10%+13例抗-HLAⅠ+Ⅱ均≥10%+3例HLAⅠ≥10%的HLAⅡ轻度致敏者)检出HLAⅡ类抗体,包括:抗-HLA-DR 12种,抗-HLA-DP 3种,抗-HLA-DQ 5种。结论 PRA能够反映肾衰竭患者是否存在针对HLA抗原的抗体及其水平,反映患者致敏状态,本研究提示患者女性较男性易产生抗-HLA,HLAⅠ类抗体较Ⅱ类抗体易产生,某些抗原易导致特异性抗体的生成,如A23等,与其抗原频率无关。Objective To analyze the level of panel reactive antibody as well as the type and frequency of anti-HLAⅠ,Ⅱ in renal failure patients. Methods PRA of anti-HLAⅠ,Ⅱ in serum were detected using ELISA method(US One lambda), and the results from a total of 519 renal failure patients from January 2010 to April 2018 were analyzed by HLA Fusion soft. Results Of the 519 patients, 0-10% mild sensitization of PRA accounted for 26.6%(29/109);10%-50% moderate sensitization accounted for 47.71%(52/109)and ≥50% high sensitization for 25.69%(28/109). The PRA sensitization rates of male and female patients were 17.6%(72/409)and 33.64%(37/110), respectively.The difference was statistically significant, suggesting that female patients were more likely to produce anti-HLA antibodies than male. 80 cases with PRA-positive were detected in all patients(15.41%,80/519), including anti-HLAⅠ positive patients in 8.86%(46/519), anti-HLAⅡpositive in 4.05%(21/519), anti-HLAⅠ+Ⅱpositive in 2.5%(13/519). Among PRA-positive patients: 65 cases(including 46 cases of HLA Ⅰ≥10%,13 cases of anti-HLA Ⅰ+Ⅱ≥10%, 6 cases of HLA Ⅰ mild sensitization with HLA Ⅱ≥10%) of HLA Ⅰ antibodies were detected, includingHLA-A in 19, HLA-B in 21 and HLA-C in 4;HLA Ⅱ antibody was detected in 37 patients(including 21 cases of HLA Ⅱ≥10%,13 cases of anti-HLA Ⅰ+Ⅱ≥10%, 3 cases of HLA Ⅱ mild sensitization with HLA Ⅰ ≥10%), including HLA-DRin 12, HLA-DP in 3 and HLA-DQ in 5. Conclusion PRA can reflect whether the patient has antibodies against HLA and the antibody levels, reflecting the patient′s sensitization status. This study suggests that female patients were more likely to produce anti-HLA antibodies than male, HLA Ⅰ antibodies are more likely to be produced than others, and some antigens are likely to lead to the production of specific antibodies, such as A23, etc.,regardless of their antigenic frequency.

关 键 词：群体反应性抗体 肾衰竭 HLA 

分 类 号：R457.11[医药卫生—治疗学] R446.6[医药卫生—临床医学]