无功能移植肾切除对致敏受者的抗HLA抗体的影响

The effect of nonfunctioning allograft nephrectomy on the level of anti-HLA antibody in sensitive recipients

目的探讨无功能移植肾切除对致敏受者的抗HLA抗体的影响。方法采用Lambda公司生产的抗原板(LAT)、微量酶联免疫吸附法,测定51例致敏患者无功能移植肾切除前后外周血中特异性抗HLAⅠ类和Ⅱ类抗体水平,分析其变化的临床意义。结果移植肾切除前单纯抗Ⅰ类抗体升高者15例(29.4%),其抗HLAⅠ类抗体水平在术后12个月时由切除前的(49.97±27.07)%下降至(31.01±27.87)%,差异有统计学意义,且轻度升高者的下降程度明显大于中度以上升高者(P<0.05);移植肾切除前单纯抗Ⅱ类抗体升高者12例(23.5%),术后3个月时抗HLAⅠ类和Ⅱ类抗体分别由(4.18±1.36)%和(58.34±21.04)%升高至(13.38±13.11)%和(79.56±18.96)%,差异有统计学意义,没有一例患者的抗HLAⅡ类抗体能降至正常水平;移植肾切除前抗Ⅰ类和Ⅱ类抗体均升高者24例(47.1%),术后6个月时两类抗体的水平较术前明显下降,此后抗HLAⅠ类抗体水平升高,而抗HLAⅡ类抗体则继续下降,但多数患者的两类抗体水平仍>30%。结论单项抗HLAⅠ类抗体升高,且抗体水平≤30%的致敏受者适合切除功能丧失的移植肾。

Objective To explore the effect of nonfunctioning allograft nephrectomy on the level of anti-HLA antibody in sensitive recipients. Methods One Lambda LAT antigen plate was adopted to estimate the level of peripheral blood specific anti-HLA Ⅰ and Ⅱ antibody by emzyme-linked immunosorbent assay for 51 sensitive recipients before and after operation regularly. The significance of the variation of the level of anti-HLA antibody was analyzed. Results The level of anti-HLA Ⅰ antibody was elevated simply in 15 cases （29.4 %） before nephrectomy, and dropped significantly from （49. 97 ±27. 07）% to （31. 01±27.87） % 12 months post-operation. The decreasing degree of PRA was greater in mild elevation patients than in moderate or severe elevation patients （P〈0. 05）. In 12 patients （23. 5%） with the simply elevated level of anti-HLA Ⅱ antibody pre-operation, the level of anti-HLA Ⅰ and Ⅱ antibody was significantly ascended from （4. 18± 1.36） % and （58. 34 ± 21.04） to （13.38± 13. 11） % and （79. 56 ± 18. 96） % respectively （P〈0. 05） at 3rd month post-operation. There was no patient whose level of anti- Ⅱ antibody could subside to normal levels. The level of anti-HLA Ⅰ and Ⅱ antibody was both elevated in 24 cases （47. 1 %） before nephrectomy and decreased significantly at 6th month post-operation, then the level of anti-HLA Ⅰ antibody was increased but the level of anti-HLA Ⅱ antibody continued to fall. Both of the levels of anti-HLA Ⅰ and -Ⅱ antibody were 〉30 % in the majority of the cases. Conclusion The nonfunctioning graft nephrectomy may be a choice for the sensitive recipients only with the elevated level of anti-HLA Ⅰ antibody less than 30 %.