抗HLA-Ⅱ类抗体对移植肾长期存活影响的研究

Study on the influence of HLA-Ⅱ antibody on long term survival of transplanted kidney

目的研究肾移植术后抗HLA-Ⅱ类抗体对移植肾长期存活的影响。方法根据Terasaki基金会举办的2007年厦门会议的要求,对肾移植术后患者检测群体反应性抗体(PRA),并长期观察移植肾功能(血肌酐尿素氮)。2007年检测出156例肾移植术后抗HLA-II类抗体阳性患者,于2012年6月进行移植肾功能观察总结。PRA检测采用美国莱姆德公司提供的酶联免疫吸附法筛选HLA-Ⅰ类、Ⅱ类混合抗原板。血肌酐和尿素氮检测数据由检验科提供。由于肾移植患者术后导致肾功能下降的因素较多,故把血肌酐/尿素氮正常值115μmol/L/7.14 mmol/L提至130μmol/L/9 mmol/L。结果 2007年检测出的156例抗HLA-Ⅱ类抗体阳性患者中,102例患者移植肾功能基本正常。经过5年连续观察(2012年),102例患者中移植肾完全失去功能的患者6例,占5.77%(6/102);肾功能降低的患者16例,占15.69%(16/102);肾功能正常的患者80例,占78.43(80/102)。54例移植肾功能下降患者,占34.62%(54/156)。经过5年连续观察(2012年),目前移植肾完全失去功能的患者30例,占55.56%(30/54);肾功能降低的患者18例,占33.33%(18/54);肾功能恢复正常的患者6例,占11.11%(6/54)。抗HLA-Ⅱ类抗体阳性患者移植肾功能正常者与移植肾功能下降者,5年后两者间具有非常显著性差异(χ2=30.29,P<0.001)。结论抗HLA-Ⅱ类抗体是移植肾功能丧失的重要因素之一,但只有在移植肾功能下降时,才可增加移植肾功能丧失的几率。

Objective To study the influence of HLA - Ⅱ antibody on long term survival of transplanted kidney. Methods According to the demands of Terasaki fund hold in Xiamen in 2007, PRA tests were conducted after transplantation, renal function （ serum levels of creatinine and urea nitrogen） was observed for a long term. 156 patients showed positive HLA -Ⅱ during post -transplantation period in 2007, their renal functions were observed and summarized in June, 2012. PRA were detected by using LAT - 1240, OneLambda. Serum levels of creatinine and u- rea nitrogen were examined by clinical laboratory. There were many factors causing decrease of renal function after transplantation, so the normal criteria of serum levels of creatinine and urea nitrogen were raised from 115 μmol/L and 7.14 mmol/L to 130μmol/L and 9 mmol/L. Results 156 patients showed HLA - Ⅱ positive in 2007, and 102 recipients of them showed normal renal fuction. After follow - up for 5 successive years （in 2012） , 6 receipients lost their renal function, accounted for 5.77% （6/102） ; renal function was decreased in 16 recipients, accounted for 15.69% （ 16/102 ） ; and renal function kept normal in 80 patients, accounted for 78.43% （ 80/102 ）. Renal function of transplanted kidney had been decreased in 54 receipients, accounted for 34.62% （54/156）. After follow - up for 5 successive years （in 2012）, the transplanted kidney completely lost its renal function in 30 recipients, accounted for 55.56% （30/54） ; renal function was decreased in 18 recipients, accounted for 33.33% （18/54） ; and renal function kept normal in 6 patients, accounted for 11.11% （6/54）. There was significant difference in patients with positive HLA - Ⅱ antibody.between transplanted kidney with normal renal function and those with decreased renal function after follow - up for 5 years （ χ2 = 30.29, P 〈 0.001 ）. Conclusion HLA - Ⅱ antibody is one of the important factors causing lost function of graft, however, the prob- ability of lost function of graft is increased only when the renal function is decreased.