终末期肾脏疾病患者MICA与HLA致敏的相关性

Association between sensitization against MICA and HLA in ESRD patients

目的探讨终末期肾脏疾病(ESRD)患者中主要组织相容性复合体Ⅰ类相关链A(MICA)抗原与人类白细胞抗原(HLA)致敏的相关性。方法根据HLA致敏情况将60例ERSD患者分为HLA致敏组(n=30)和非HLA致敏组(n=30)并采集临床资料,采用ELISA方法进行HLA致敏情况分析、Luminex100免疫磁珠流式细胞仪进行MICA致敏情况分析。结果HLA致敏患者都存在输血、妊娠和(或)移植史,HLA致敏组有输血史和移植史的患者百分率均高于非HLA致敏组(均P<0.05);两组中MICA致敏的患者共17例,其中16例有输血、妊娠和(或)移植史,1例既往无输血和移植史、无HLA致敏的32岁男性患者存在MICA致敏。HLA致敏组中MICA致敏率高于非HLA致敏组(40.0%vs16.7%,2=4.02,P<0.05)。结论HLA致敏与输血、移植、妊娠相关,而MICA致敏的途径尚未完全清楚,除输血、妊娠和移植等致敏途径外,可能存在天然的抗-MICA抗体。MICA致敏与HLA致敏之间存在相关性,这种伴随关系可能与输血、妊娠或移植等途径共同致敏有关。对非HLA致敏占大多数的ERSD患者进行MICA致敏状态的监测,将有助提高ERSD患者肾移植的长期生存率和远期移植效果,进一步增加肾移植的安全性。

Objective To investigate me association of sensitization against MICA （Major histocompatibility com- plex class I -related chain A） and HLA （human leucocyte antigen） in end - stage renal disease （ESRD） patients. Methods According to the status of HLA sensitized,60 patients were divided into HLA sensitized group （ n = 30） and HLA nonsensitized group（ n = 30）. Clinical data was collected. ELISA was used to identify HLA antibody. Luminex flow cy- tometry was used to identify MICA antibody and antibody specificity in both groups. Results Each HLA sensitized patient had the history of transfusion, pregnancy and/or transplantation. Compared to HLA nonsensitized group, HLA sensitized group had a significantly higher percentage of transfusion and transplantation （P 〈 0. 05, respectively）. Sixteen patients sensitized against MICA had the history of transfusion, pregnancy and/or transplantation in total 17 MICA sensitization pa- tients, but no such a history was found in a 32 year old male with MICA sensitization and without HLA sensitization. Com- pared to HLA nonsensitized group, MICA sensitized rate was significant higher in HLA sensitized group（40% ：16.67%, X2 = 4. 02,P 〈 0.05）. Conclusions HLA antibody positive patients have the history of HLA sensitization, but mecha- nism of MICA sensitization remained unclear. In addition to transfusion, pregnancy or transplantation, nature MICA anti- body can occur. There is association between sensitization against MICA and HLA, which is associated with common sen- sitization via transfusion, pregnancy or transplantation. Monitoring the sensitized status of MICA, especially for the HLA nonsensitized of ESRD patients in majority, would enhance survival and effect in long - term renal transplantation.