抗人类白细胞抗原与抗组织相容性Ⅰ类相关链A位点特异性抗体对移植肾功能的监测价值

The impact of Anti-HLA and Anti-MICA specific antibodies on allograft function of kidney trans- plant

目的探讨抗人类白细胞抗原（HLA）与抗主要组织相容性Ⅰ类相关链A位点（MI—CA）抗体在移植肾功能中的意义。方法采用免疫磁珠流式液相芯片技术检测135例等待肾移植患者中的抗HLA和抗MICA抗体，其中33例肾移植患者接受了2年的动态随访；采用PCR—SSOP方法进行HLA和MICA基因分型并鉴定供者特异性抗体（DSA）和非供者特异性抗体（NDSA），结合血清肌酐水平和临床资料进行分析。结果34．1％等待肾移植患者（46／135）预存抗HLA和抗MICA抗体。动态随访33例肾移植患者：20例患者移植前后抗体均阴性；10例患者移植前后抗体阳性且类型未改变；3例患者移植6个月后产生新生抗体（9．1％）。2例移植前抗体阴性，移植后6个月新生A33、A31和DQ7、DR17、DR18为NDSA抗体，移植后1、2年新生DR12和DR11为DSA抗体；1例移植后1年新增MICA27和MICA02特异性抗体的同时新生HLA，B41、A32抗体。在33例肾移植患者中，抗体阳性组患者与抗体阴性组比较差异有统计学意义（P〈0．05）；MICA抗体阳性组患者的血清肌酐水平升高更明显（P〈0．01）。结论无论肾移植前患者是否预存抗HLA和抗MICA抗体，移植后动态监测抗HLA和抗MICA特异性抗体的变化，对预警排斥反应的发生和指导临床治疗来防止移植肾功能减退均具有一定价值。

Objective To explore the impact of anti-HLA and MICA antibodies on kidney graft function by dynamic monitoring for two years. Methods The 135 patients to be subject to renal allograft were detected for specificity of anti-HLA and anti-MICA antibodies by flow PRATM beads. Among them 33 patients accepted two-year dynamic monitoring. Also the HLA and MICA genotyping was done by using PR-SSOP,and donor specific antibody （DSA） and non-donor specific antibody （NDSA） were identified. Simultaneously,the serum creatinine levels and clinical data were analyzed. Results The 46 patients were positive for antibody before transplantation in 135 patients （34.1%）. Among the 33 patients subject to dynamic monitoring,20 patients were negative for anti-HLA and anti-MICA antibodies before and after transplantation ：7 patients had anti-MICA antibody：2 patients were positive for both anti-HLA and anti-MICA antibodies：one patient was positive for antiHLA antibody,and the remaining 3 patients developed de novo antibody at 6th month after transplantation （9. 1% ）. Two patients negative for antibodies before transplantation had de novo antibodies：A33,A31 （one case）, and DQ7,DR17,DR18 （one ease） at the 6th month after transplantation,then specific antibodies were DR12, and DR11 at first to second years after transplantation. One patient had de novo MICA27, MICA02 antibody and HLA-B41 ,A32 antibodies one year after transplantation. There was significant difference in the Scr levels in 33 patients between positive and negative antibody groups （ P 〈 0.05 ）. The Ser levels were most significantly increased in anti-MICA antibody group （P 〈 0. 01 ）. Conclusion Whether there is HLA and MICA antibodies before transplantation, dynamic monitoring of the changes in HLA and MICA specific antibodies after transplantation is of great importance in predicting rejection and guiding clinical therapy to prevent the occurrence and development of renal allograft function deficiency.