高危角膜移植术前HLA配型的初步研究

THE INITIAL CLINICAL RESEARCH OF HLA MATCHING IN HIGH - RISK KERATOPLASTY BEFORE TRANSPLANTATION

目的:初步评价高危角膜移植术前供者与受者进行HLA配型的临床意义。方法:将角膜新生血管≥2个象限或结膜上皮化的角膜、药物治疗无效的全角膜溃疡列为高危角膜,44例(44跟)。一步单抗法检测Ⅰ类抗原,DNA法检测HLA-Ⅱ类抗原。根据HDA位点的相配数分为4组:HLA的2错配、3错配、4错配、5错配。结果:术后排斥反应发生率为79.5%(35/44),2错配组为9.1%(4/44),3错配组为11.3%(5/44),4错配组为27.3%(12/44),5错配组为31.8%(14/44),其中4错配和5错配的排斥反应率高达59.1%(26/44),而2错配和3错配排斥反应率则为20.4% (9/44),高错配组的排斥反应率远高于低错配组。结论:对高危角膜患者,HLA高错配组的排斥反应率高于低错配组,术前进行组织相容性抗原HLA配型有临床指导意义。

Objective: To evaluate the importance of human leucocyte antigen (HLA) matching in high - risk keratoplasty before transplantation. Method: There were 44 eyes which were ill with rich corneal neovascularization or whole corneal ulcer with no drug treatment effect of sclerocornea after eye trauma. HLA -Ⅰ were typed by monoclonial antibody method and HLA -Ⅱ were typed by DNA-based method before surgery.The cases were divided into 4 groups of 2、3、4、5 HLA mismatching (MM) .High mismatching group is composed of 4 MM、5MM and low mismatching group is composed of 2MM、 3MM.Results: The immunological rejection rate was 79.5% (35/44), in which rejection rate was 9.1 % (4/44) in 2 MM, 11.3% (5/44) in 3 MM, 27.3% (12/44) in 4MM, 31.8% (14/44) in 5 MM.The rejection rate was much higher in high mismatching group of 4MM and 5MM (59.1%) than in low mismatching group of 2 MM and 3 MM (20.4%) . (P = 0.044<0.05) .Conclusion: The results showed that HLA matching before corneal transplantation play an important role in keratoplasty. If necessary, we should choose the better matched donor - recipient in high - risk keratoplasty before transplantation to reduce the immunological rejection according to the HLA matching results.