双柱蛋白A免疫吸附脱敏治疗用于高致敏肾移植患者清除HLA抗体的疗效观察及护理  

Clinical observation and nursing care of sensitized kidney transplant recipients treated with combined desensitization based on double-column protein A immunoadsorption for clearing HLA antibodies

作　　者：陈晓飞 王玉霞 王美佳 余波光 董沛坚 冯志仙 CHEN Xiaofei;WANG Yuxia;WANG Meijia;YU Boguang;DONG Peijian;FENG Zhixian(Department of Nephrology,Shulan(Hangzhou)Hospital,Zhejiang Shuren University Shulan International Medical College,Hangzhou 310000,China;Guangdong Provincial Key Laboratory of Hemoadsorption Technology,Guangzhou 510660,China)

机构地区：[1]浙江树人大学树兰国际医学院附属树兰(杭州)医院血液净化中心,浙江杭州310000 [2]广东省血液净化吸附技术企业重点实验室,广东广州510660

出　　处：《温州医科大学学报》2023年第8期651-656,共6页Journal of Wenzhou Medical University

基　　金：杭州市医药卫生科技项目(B20200629);广东省科技计划项目(2020B121202021)。

摘　　要：目的:探讨双柱蛋白A免疫吸附治疗对高致敏肾移植患者抗HLA抗体的清除效果及护理措施,为高致敏患者肾移植的脱敏治疗提供有效治疗路径及护理方法。方法:选取2017年7月至2022年7月于树兰(杭州)医院术前、术后接受蛋白A免疫吸附治疗的肾移植患者48例,其中双柱组27例,行双柱蛋白A免疫吸附治疗;单柱组21例,行单柱蛋白A免疫吸附治疗。先收集双柱组患者治疗前1324个HLA抗体位点(MFI>2000)以及相应位点在免疫吸附后(1、4、7、10次)的MFI值,并分析不同类型和MFI范围的抗体下降率的改变;记录并总结上述治疗的护理措施。再比较两组患者的年龄、体质量、治疗血浆量、治疗时间及抗凝剂用量。结果:两组患者年龄、体质量差异均无统计学意义(P>0.05)。与单柱组患者比较,双柱组患者的治疗血浆量更大,且显著降低体外循环时间(P<0.001)和抗凝剂用量(P<0.001)。双柱组经10次免疫吸附治疗后,I类抗体MFI值从8298.6(4450.4,14003.1)下降至3196.2(676.5,9266.9),下降率为66.80%(33.17%,90.48%);II类抗体从13521.1(6153.6,20440.0)下降至2773.3(415.9,11192.5),下降率为71.14%(26.95%,100%)。双柱蛋白A免疫吸附治疗对II类强阳性的清除作用比I类强阳性更高(P=0.015),下降率分别为62.59%(25.17%,91.04%)和45.13%(32.70%,73.94%)。结论:双柱吸附系统可以有效清除HLA抗体,提高医疗工作效率,与单柱比可以缩短治疗时间,降低抗凝剂用量,减少围手术期出血风险。Objective:To investigate the clearance effects of desensitization therapy on human leukocyte antigen(HLA)antibodies so as to provide a reference formulation of nursing practice on immunoadsorption therapy with double-column.Methods:Totally 48 kidney transplant recipients who received preoperative/postoperative desensitization therapy based on Protein A Immunoadsorption(PA-IA)therapy in combination with drug therapy in Shulan(Hangzhou)Hospital from July 2017 to July 2022 were enrolled,of whom 27 treated with double-column and 21 with single-column.For the patients with double-column treatment the pre-treatment mean fluorescence intensity(MFI)of 1324 HLA antibody specificities(MFI>2000)and the post-treatment MFI of the corresponding antibody specificities(after 1,4,7,and 10 sessions)were recorded for analysis of the changes in antibody level reduction for the different antibody classes and MFI ranges.The operation procedure of double column immunoadsorption and nursing measures were recorded and summarized.The age,weight,regenerated plasma volume,treatment time and anticoagulant dosage of the two groups were compared.Results:There was no statistically significant difference in the baseline data between the two groups(P>0.05),the regenerated plasma volume of two-column group is larger than that of single-column(P<0.05).Compared with single-column therapy,double-column therapy significantly reduced extracorporeal circulation time(P<0.001)and anticoagulant dosage(P<0.001).After 10 sessions of two-column therapy,the MFI of class I antibodies decreased from 8298.6 to 3196.2(reduction of 66.80%),while the MFI of class II antibodies decreased from 13521.1 to 2773.3(reduction of 71.14%).The clearance effect of PA-IA therapy were was better on strongly positive(MFI>10000)class II antibodies than on strongly positive class I antibodies,showing a respective reduction(P=0.015)of 62.59%(25.17%,91.04%)and 45.13%(32.70%,73.94%).Conclusion:Double-column immunoadsorption system can remove effectively HLA antibody,significantly redu

关 键 词：肾移植 抗人类白细胞抗原抗体 脱敏治疗 双柱蛋白A免疫吸附 护理 

分 类 号：R457.2[医药卫生—治疗学] R473[医药卫生—临床医学]