单剂小剂量利妥昔单抗降低致敏肾移植等待者HLA抗体的效果及机制  

Effect and mechanism of single low-dose rituximab in reducing HLA antibody of sensitized patients awaiting kidney transplantation

作　　者：田凯文 程守钰 朱平[3] 刘艳君[3] 刘桂欢 林恩宇 汤延淋 曾加义 叶楚津[2] 余玉明 TIAN Kaiwen;CHENG Shouyu;ZHU Ping;LIU Yanjun;LIU Guihuan;LIN Enyu;TANG Yanlin;ZENG Jiayi;YE Chujin;YU Yuming(School of Medicine,South China University of Technology,Guangzhou 511436,Guangdong,China;Department of Urology,Guangdong Provincial People’s Hospital,Guangzhou 510080,Guangdong,China;Department of Immunology,School of Basic Medical Science,Southern Medical University,Guangzhou 510515,Guangdong,China)

机构地区：[1]华南理工大学医学院,广东广州511436 [2]广东省人民医院泌尿外科,广东广州510080 [3]南方医科大学免疫学教研室,广东广州510515

出　　处：《暨南大学学报（自然科学与医学版）》2022年第5期493-499,共7页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省自然科学基金项目(2019A1515010234);广州市科技计划项目(202002030060)。

摘　　要：目的:探讨单剂小剂量利妥昔单抗(RTX)对等待肾移植的致敏患者脱敏治疗的效果及机制,观察单剂小剂量RTX作用下致敏患者体内B淋巴细胞的动态变化规律。方法:分析8名等待肾移植的致敏患者使用单剂小剂量(200 mg)RTX脱敏方案治疗前、后的临床资料,使用Luminex单抗原珠和流式细胞术对致敏患者抗人类白细胞抗原(HLA)抗体及外周血B淋巴细胞的变化情况进行动态观察。结果:抗HLA抗体在用药后3个月可降至用药前水平的(46.03±13.09)%;致敏患者外周血中B淋巴细胞在RTX治疗后2周内清除,6个月时仍处于较低水平(24.1±17.4)个细胞/μL,B淋巴细胞重建以CD19^(+)CD5^(+)B1细胞和CD19^(+)IgD^(+)CD27^(-)幼稚性B细胞为主。结论:单剂小剂量RTX可降低部分致敏患者抗HLA抗体强度,患者外周血B淋巴细胞重建在用药后6个月仍处于较低水平。Objective:To investigate the effect and mechanism of single and low-dose rituximab(RTX)on the desensitization of sensitized patients in kidney transplant waitlist and summarize the dynamic changes of B lymphocytes in sensitized patients under the effect of RTX.Methods:Clinical characteristics of eight sensitized patients before and after received single and low-dose RTX(200 mg)for desensitization were collected and analyzed.The concentration of anti-human leukocyte antigen(HLA)antibody and the dynamic changes of B lymphocytes of all 8 patients were observed by flow cytometry and Luminex single antigen beads.Results:The concentration of anti-HLA antibody decreased to(46.03±13.09)%of the baseline level after the treatment for 3 months.The B lymphocytes in the peripheral blood of sensitized patients were cleared within 2 weeks and remained at a low level(24.1±17.4)cells/μL at the 6 month.The reconstructed B lymphocytes were mainly CD19^(+)CD5^(+)B1 cell and CD19^(+)IgD^(+)CD27^(-)naive B cell groups.Conclusion:Single and low-dose RTX can reduce the intensity of anti-HLA antibody in part of the sensitized patients,and the reconstruction of peripheral blood B lymphocytes remained at low level 6 months after the treatment.

关 键 词：肾移植 致敏患者 抗HLA抗体 利妥昔单抗 B淋巴细胞 

分 类 号：R699.2[医药卫生—泌尿科学]