Eplet匹配对肾移植术后供者特异性抗体产生及急性排斥反应发生的影响  

Effects of Eplet matching on donor specific antibody production and acute rejection after renal transplantation

作　　者：匡培丹 张璇 张颖[1] 丁小明[1] 薛武军[1] 雷艳君 郑瑾[1] KUANG Peidan;ZHANG Xuan;ZHANG Ying;DING Xiaoming;XUE Wujun;LEI Yanjun;ZHENG Jin(The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an710061,China)

机构地区：[1]西安交通大学第一附属医院,西安710061

出　　处：《山东医药》2020年第34期1-5,共5页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81670682);西安交通大学第一附属医院临床研究课题(2018XJTUYFY026)。

摘　　要：目的探讨供受者人类白细胞抗原(HLA)功能性表位(Eplet)匹配错配数与肾移植术后供者特异性抗体(DSA)产生和急性排斥反应发生的关系。方法选择接受肾移植术患者787例,其中死亡捐献(DD)受者632例、亲属活体捐献(LRD)受者155例。采用HLA Matchmaker软件分析供受者Eplet匹配错配数。分析供受者Eplet匹配错配数与HLA氨基酸残基(Res M)匹配、HLA抗原匹配错配数的关系,DD与LRD供受者HLA匹配效果,Eplet匹配错配数与肾移植术后DSA产生和急性排斥反应发生的关系。采用受试者工作特征(ROC)曲线评估HLA Eplet匹配错配数对肾移植术后DSA产生和急性排斥反应发生的预测价值。结果供受者HLA A、B、DR位点Eplet匹配错配数与Res M匹配错配数呈正相关关系(P<0.01),供受者HLA A、B、C、DR、DQ位点Eplet匹配错配数与HLA抗原匹配错配数亦呈正相关关系(P<0.01)。LRD供受者Eplet匹配错配数低于DD供受者(P<0.01)。LRD受者肾移植术后DSA阳性率和急性排斥反应发生率均低于DD受者肾移植术后(P均<0.01)。群体反应性抗体阳性与阴性受者、DSA阳性与阴性受者Eplet匹配错配数比较差异均有统计学意义(P均<0.05)。发生急性排斥反应受者Eplet匹配错配数高于未发生急性排斥反应受者(P<0.05)。ROC曲线分析显示,Eplet匹配错配数预测肾移植术后DSA产生的曲线下面积(AUC)为0.719(95%CI:0.621~0.817,P<0.05),其截断(cut off)值为78.59,此时其预测肾移植术后DSA产生的敏感度为71%、特异度为79%;Eplet匹配错配数预测肾移植术后急性排斥反应发生的AUC为0.737(95%CI:0.646~0.828,P<0.05),其cut off值为75.43,此时其预测肾移植术后急性排斥反应发生的敏感度为70%、特异度为78%。结论供受者Eplet匹配错配数与HLA抗原匹配错配数和Res M匹配错配数密切相关,并可影响肾移植受者术后DSA产生和急性排斥反应发生。Objective To investigate the relationship of Eplet matching with the donor specific antibody(DSA)production and acute rejection after renal transplantation.Methods Totally 787 cases of kidney transplantation,including 632 cases of deceased donation(DD)and 155 cases of living relative donation(LRD)were recruited.Recipients and donors Eplet mismatch number was analyzed by HLA Matchmaker software.The relationships of recipients and donors Eplet mismatch number with the HLA Res M mismatch number and HLA antigen mismatch number,the DD and LRD donor HLA matching effect,the relationship between donor Eplet mismatch number and DSA production after kidney transplantation,and the effect of donor Eplet mismatch on acute rejection after kidney transplantation were compared.The predictive value of HLA Eplet mismatch number in DSA production and acute rejection after renal transplantation was evaluated by receiver operating characteristic(ROC)curve.Results The recipient Eplet mismatches on HLA A,B,and DR sites were positively correlated with the Res M mismatches(all P<0.01),and the recipient Eplet mismatches on HLA A,B,C,DR,DQ sites were also positively correlated with the HLA antigen mismatches(all P<0.01).The mismatch number of LRD donors and recipients Eplet matching was lower than that of DD ones(P<0.01).The DSA positive rate and acute rejection rate of LRD recipients after renal transplantation were lower than that of DD recipients(all P<0.01).There were significant differences in the Eplet mismatches between PRA positive and negative recipients,and between DSA positive and negative recipients(all P<0.05).The number of Eplet mismatches in recipients of acute rejection was higher than that of recipients without acute rejection(P<0.05).ROC curve analysis showed that the the AUC of Eplet mismatch in predicting the DSA production after renal transplantation was 0.719(95%CI:0.621-0.817,P<0.05),and its cut-off value was 78.59,with the sensitivity of 71%and specificity of 79%.The AUC of Eplet mismatch number in predicting acute

关 键 词：肾移植 功能性表位匹配 供者特异性抗体 急性排斥反应 

分 类 号：R692.5[医药卫生—泌尿科学]