33例非O型ABOi肾移植受者围术期血型抗体的变化  

Changes in perioperative blood group antibody of 33 type-A/B recipients in ABO-incompatible kidney transplantation

作　　者：靳慧芳[1] 孔永奎[1] 刘欣[1] 王书亚 陈李影慧[1] 杨昊 李金峰[2] 杨乾坤[1] JIN Huifang;KONG Yongkui;LIU Xin;WANG Shuya;CHEN Liyinghui;YANG Hao;LI Jinfeng;YANG Qiankun(Department of Blood Transfusion,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Renal Transplantation,the First Affiliated Hospital of Zhengzhou University)

机构地区：[1]郑州大学第一附属医院输血科,河南郑州450052 [2]郑州大学第一附属医院肾移植科

出　　处：《中国输血杂志》2024年第5期534-540,共7页Chinese Journal of Blood Transfusion

基　　金：河南省医学科技攻关计划项目(2018020026)。

摘　　要：目的统计分析非O型ABO血型不相合肾移植(ABOi-KT)受者围手术期结果资料,旨在探寻ABOi-KT患者血浆中血型抗体的变化情况。方法回顾性分析本院2021年1月—2023年10月首次肾移植、血型仅为A型和B型的33对ABOi-KT供、受体的临床资料,供者血型均为AB型,依据受者血型的不同,分为AB供A组(n=18)和AB供B组(n=15)。分析比较术前血浆置换对2组患者抗体效价的影响,术后2组患者血型抗体反弹和肾功能指标(术后d 1、3、7、14的尿素氮、肌酐和肾小球滤过率)的差异。依据术后血型抗体反弹与否,分为抗体反弹组(n=7)和非反弹组(n=26),分析比较初始效价在血型抗体反弹和非反弹组的差异。结果术前血浆置换对患者IgM抗体的清除率在2组间的差异无统计学意义(Z=-0.260,P>0.05);术后d 1、3、7、14,2组患者肾功指标均无统计学差异;AB供B组术后更易出现血型抗体效价反弹(P<0.05);初始IgM抗体效价在血型抗体反弹组和非反弹组有统计学差异(Z=-2.127,P<0.05),但是初始IgG抗体效价(Z=-1.835,P>0.05)在2组间无统计学意义。结论与AB供A组相比,术后AB供B的患者更易发生血型抗体效价反弹。Objective To statistically analyze the perioperative results of patients with ABO-incompatible kidney transplantation(ABOi-KT),in order to explore the changes in blood group antibody of type-A/B recipients.Methods A total of 33 cases of blood group A/B ABOi-KT recipients in our hospital from January 2021 to October 2023 were recruited and divided into two groups of group A(n=18)and group B(n=15)according to the different blood types of recipient.The effects of preoperative plasmapheresis on antibody titer,antibody rebound and renal function after operation(serum urea nitrogen,creatinine and estimated glomerular filtration rate(eGFR)on the 1st,3rd,7th and 14th day)were analyzed between the two groups.According to the postoperative rebound of blood type antibodies,33 recipients were divided into two groups of antibody rebound group(n=7)and non rebound group(n=26),and the differences in initial blood type antibody titers between the two groups were analyzed.Results There was no significant difference in the clearance rate of IgM with preoperative plasma exchange between the two groups(Z=-0.26,P>0.05);Levels of serum urea nitrogen and creatinine on the 1st,3rd,7th and 14th day after operation between group A and group B were not statistically significant(P>0.05),the same as eGFR.Group B was more prone to rebound antibody compared with group A(P<0.05).There was a significant difference in the initial IgM antibody titer between the blood type antibody rebound group and the non rebound group(Z=-2.127,P<0.05),but no statistically significant difference in the initial IgG antibody titer(Z=-1.835,P>0.05)between the two groups was found.Conclusion The patients type B receiving type AB kidney donors are more prone to rebound antibody after ABOi-KT operation compared to the the patients type A receiving type AB.

关 键 词：ABO血型不相合肾移植 血浆置换 抗体效价 围术期 

分 类 号：R457.14[医药卫生—治疗学] R322.61[医药卫生—临床医学]