肾移植患者抗HLA抗体动态监测的临床意义-东南大学学报医学版

肾移植患者抗HLA抗体动态监测的临床意义

单位：南京医科大学第一附属医院,泌尿外科,江苏,南京,210029

分类号：R669.2, R392.4, R446.62

出版年·卷·期（页码）：2003·22·第四期（257-259）

摘要：

目的:研究肾移植患者手术前后抗HLA抗体的水平与移植肾急性排斥的关系.方法和结果:采用美国加州大学的泰萨奇板检测法,对46例尸体肾移植患者(男34例,女12例;年龄20～63岁)进行手术前,术后1周、2周、1个月血清中的群体反应性抗体(PRA)检测,并分析其与肾移植急性排斥的关系.46例患者中,移植前PRA阳性者(PRA>10%)13例(28.3%),PRA阴性者33例(71.7%).移植前PRA阳性者中有6例PRA>50%(51%～80%),术前行血浆置换,并口服免疫抑制剂.肾移植后PRA阳性组中有6例发生急性排异,其中2例甲基泼尼松龙(MP)冲击失败后切除移植肾恢复血透.PRA阴性组中有6例发生急性排异,其中3例经MP冲击治疗后肾功能恢复正常,1例经MP冲击无效,改用抗T淋巴细胞球蛋白(ATG)冲击后,肾功能恢复正常.两组相比排异发生率有统计学差异(P<0.05).术后PRA阳性者有17例(其中术前PRA阴性者4例),发生排异者9例(其中3例为术前PRA阴性).术后PRA阴性者中有3例发生排异.两组相比排异发生率有统计学差异(P<0.05).结论:患者肾移植术前体内PRA水平对移植肾排异有显著影响,术后体内PRA水平影响移植肾急性排异的发生和转归.

Objective To study the relationship between the level of anti-HLA antibody in kidney recipients before and after operation and the acute rejection of the graft.Methods and Results Forty-six kidney recipients,34 males,12 females,20～63 years were involved.The ELISA?PRA method of California University(terasaki method) was used to determine the level of antibody preoperatively,1 week,two weeks and 1 month postoperatively,and its relation to acute rejection was studied.Before transplantation,13 cases were positive(28.3%) by PRA(PRA>10%),33 other cases were negative(71.75%).Of all the positive,there were 6 cases in which PRA>50%.They received the therapy of serum exchange and immunosuppresents before operation.In the group of positive PRA,6 cases of acute rejeciton occured postoperatively.Two of the grafts were removed after therapeutic failure of large dose of methylprednisolone(MP).In the group of negative PRA,6 cases of acute rejection occurred.Four of them were cured with large dose of MP,and 2 others were cured with MP and ATG.After transplantation,there were 17 cases of positive PRA(4 of them were negative before transplantation),in 9 cases of which acute rejections occured postoperatively.Three cases of rejections occured in postoperatively negative PRA group.The difference was significant(P<0.05).Conclusion The preoperative level of PRA is very important to acute rejection occurance,and postoperative level of PRA affects acute rejection and its prognosis.

参考文献：

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