人类白细胞抗原抗体对移植肾患者肾功能的影响

Impact of HLA Antibodies on Renal Function in Patients after Renal Transplantiion

目的:研究肾移植术后人类白细胞抗原(human lymphocyte antigen,HLA)抗体对不同状态移植肾患者肾功能的影响。方法:肾移植术后患者90例,根据移植肾的不同状态分为3组,即移植后肾功能持续正常组(n=32)、慢性移植肾肾病(chro-nic allograft nephropathy,CAN)组(n=23)、急性排异组(n=35)。采用Luminex技术检测所有患者外周血HLA抗体,并随访1年,分析HLA抗体在不同状态移植肾患者中的分布情况以及其对肾功能的影响。结果:CAN组患者HLA抗体阳性率为73.9%,高于正常组的46.9%,差异有统计学意义(P<0.05);急性排异组HLA抗体阳性率为60.0%,与正常组比较差异无统计学意义(P>0.05)。急性排异组HLA抗体阳性患者较阴性患者每月肾小球滤过率的下降率显著增加(P=0.011);对于CAN组和正常组的患者,HLA抗体阳性患者较阴性患者每月肾小球滤过率的下降率差异无统计学意义(P>0.05)。结论:肾移植术后HLA抗体与CAN及急性排异密切相关;对于急性排异的患者,HLA抗体出现1年内即会对移植肾的肾功能产生影响。

Objective： To investigate the influence of HLA antibodies on renal function in patients after transplantion. Methods：A total of 90 patients with a functioning graft for at least 6 months after renal transplantation were divided into three groups bases on the status of renal function, including normal group（n = 32）, chronic allograft nephropathy group （CAN group, n = 23） and acute rejection group（AR group, n = 35）. All patients have been followed up for one year. Anti-HLA antibodies were detected by Luminex methods. Results： The frequencies of anti-HLA antibodies detected in CAN group and AR group were higher compared with normal group. In AR group, patients with anti-HLA antibodies showed deteriorating renal function compared with negative ones（P = 0. 011）, but in normal group and CAN group, HLA antibodies did not show aggravating influence on transplanted kidneys in one year. Conclusions： The presence of HLA antibodies increased the risk of graft failure in patients with acute rejection.