肾移植术后抗HLA抗体升高对移植肾功能的慢性损害作用

Renal allograft function impairment by posttransplunt unti-HLA antibodies

目的探讨肾移植术后抗HLA抗体升高对移植肾功能的慢性损害作用。方法采用免疫荧光液相芯片技术检测57例肾移植术后半年以上受者的抗HLA抗体水平，根据抗HLA抗体水平的不同，将受者分为抗HLA抗体（≥10％）阳性组和抗HLA抗体（〈10％）阴性组。再根据阳性组中抗HLA抗体类别的不同，将受者分为抗HLA—Ⅰ类抗体阳性、Ⅱ类抗体阴性（Ⅰ＋Ⅱ-）组，抗HLA—Ⅰ类、Ⅱ类抗体均阳性（Ⅰ＋Ⅱ＋）组和抗HⅠ。A-Ⅰ类抗体阴性、Ⅱ类抗体阳性（Ⅰ-Ⅱ＋）组。观察和比较各组受者的临床资料和血肌酐（Cr）水平，并进行统计学分析。结果57例受者中，抗HLA抗体阴性组41例（71．9％），阳性组16例（28．1％）；阳性组中，Ⅰ＋Ⅱ-组和Ⅰ＋Ⅱ＋组受者各3例-组10例。抗HⅠ。A抗体阴性组和阳性组受者的肾移植术后时间分别为（4．55±3．16）年和（6．64±3．66）年（P〈0．05），随着术后时间的延长，抗HLA抗体阳性者呈上升趋势。抗HLA抗体阴性组有13例（31．7％）血Cr异常，平均血Cr水平为（92．12±27．52）μmol／L；阳性组有13例（81．3％）血Cr异常，平均血cr水平为（191．81±119．95）ymol／L，其中又以Ⅰ＋Ⅱ＋组的受者血Cr水平最高，为（213．00±165．38）μmol／L，与抗HLA抗体阴性组比较，差异有统计学意义（P〈O．05）。结论抗HLA抗体升高是影响肾移植预后的重要标志物；尤其是抗HLA-Ⅱ类抗体升高对移植肾功能有慢性损害作用。

Objective To explore the impact of posttransplant anti-HLA antibodies on renal allograft function. Methods Fifty seven patients with renal aUografts for at least 6 months were detec- ted for the levels and specialties of anti HLA antibodies by Flow PRA beads. The patiems were divi- ded into positive and negative groups according to different levels of anti-HLA antibodies. The positive group could be divided into three groups： anti-HLA class Ⅰ± and class Ⅱ- ; anti-HLA class Ⅰ± and class Ⅱ± ; anti HLA class Ⅰ- and class Ⅱ±. Simultaneously, their serum creatinine levels and clinical data were analyzed statistically. Results HLA antibodies were found in 28. 1% （16/57） of the total pa- tients. Three cases were positive for anti-HLA class Ⅰ, 3 for both anti-HLA class Ⅰ and class Ⅱ antibodies, and 10 （or anti-HLA class Ⅱ. The survival time of renal transplant patients was （4. 55 ±3.16） and （6. 64 ± 3.66） years in anti-HLA antibodies negative and positive groups, respectively （P〉 0. 05）. With the prolongation of time posttransplant, the positive rate of anti-HLA antibodies was in- creased. The levels of serum creatinine in 13 patients without anti-HLA antibodies were （92.12 ± 27. 52）/,mol/L, and those in 13 patients with anti-HLA antibodies were （191.81 ± 119. 95）/,mol/L. Ⅰn anti-HLA antibodies positive group, the levels of serum creatinine in Ⅰ＋ Ⅱ- group were highest （213.00± 165.38μmol/L）, and there was significant difference in comparison to anti-HLA antibodies group （P〈0. 05）. Conclusions The increases in anti-HLA antibodies could be one of the important prognostic markers in renal transplant. The renal allograft function could be impaired by the increased anti-HLA class Ⅱ.