肾移植受者术前主要组织相容性复合物Ⅰ类链相关基因A抗体对移植后早期急性排斥反应的影响

Impact of MICA antibodies on acute graft rejection early after kidney transplantation

目的探讨肾移植受者术前主要组织相容性复合物Ⅰ类链相关基因A（MICA）抗体对肾移植术后早期急性排斥反应和移植肾功能恢复的影响。方法检测2009年~2010年本院197例未使用免疫抑制剂的肾移植受者术前MICA抗体及其特异性,随访其后接受尸体肾移植手术的139例受者的术后早期急性排斥反应（AR）和移植肾功能。结果 197例肾移植受者术前MICA抗体阳性45例（22.84%）。MICA抗体特异性分析发现有11种抗体,其中出现频率最高的是抗MICA019（占65.7%）,出现频率最低的是抗MICA015（占8.6%）和抗MICA017（占8.6%）,高、低频率抗体间的差异具有显著性（χ2=24.48,P〈0.01）。45例阳性受者中单一特异性抗体18例（占51.4%）,多种特异性抗体17例（占48.6%）。197例受者中139例在术后有39例发生早期AR（占28.1%）;其中,45例术前MICA抗体阳性受者中38例接受移植后有14例发生早期AR（占36.8%）;152例术前MICA抗体阴性受者中有101例接受移植后有25例发生了早期AR（占24.8%）。结论中国人群中最常见的MICA抗体中为抗MICA019,推测MICA019为中国人群中较常见基因是其表现出临床上高频率抗体的原因。

Objective To evaluate the influence of major histocompatibility complex class I chain-related gene A（MICA） antibodies on acute rejection（AR） and renal function in early stage after renal transplantation.Methods A total of 197 renal transplant candidates admitted in Nanfang Hospital in 2009-2010 were enrolled in this study.MICA antibodies and their specificity were detected in all the patients,and 139 patients were followed up for early acute rejection（AR） and graft function after transplantation.Results MICA antibodies were positive before transplantation in 45 candidates（22.84%）.Eleven specific MICA antibodies were identified,among which the frequency of MICA019 antibody（65.7%） was significantly higher than that of MICA015（8.6%） and MICA017（8.6%）（P0.01）.Eighteen patients with positive MICA antibodies were single-specific and 17 were polyspecific（51.4% vs 48.6%）.Of the 139 patients undergoing renal transplantation,39 developed early AR（28.1%）.Of the 45 candidates positive for MICA antibodies,38 received renal transplantation and early AR occurred in 14 of them（36.8%）;101 of 152 candidates negative for MICA antibodies underwent renal transplantation,and 25 experienced early AR（24.8%）.Conclusion MICA019 antibody is a frequent MICA antibody possibly due to the high frequency MICA019 gene in Chinese population.