肾移植术后抗HLA—II类抗体对移植肾长期存活的影响研究’

Influence of HLA-II Class Antibodies on Long Survival of Patients with Renal Post-Transplant

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 2007年初对1990年手术后的肾移植患者检测群体反应性抗体（PRA）,并长期观察移植肾功能（血肌酐和尿素氮）.2007年检测出147例肾移植术后抗HLA-II类抗体阳性患者,随后每年检测同样患者1～2次PRA,并随时观测移植肾功能.群体反应性抗体检测采用酶联免疫吸附法筛选HLA-Ⅱ类抗体.血肌酐和尿素氮检测数据由检验科提供.结果 2007年检测出的147例抗HLA-II类抗体阳性患者中,移植肾功能正常患者93例,移植肾功能下降患者54例.经过5年连续观察（2007年～2012年）期间,移植肾完全失去功能的患者分别为6例和34例;肾功能下降的患者分别为16例和14例;肾功能正常的患者分别为71例和6例.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年后两者间差异具有统计学非常显著性意义（χ2=55.6967,P〈0.001）.结论 抗HLA-II类抗体是移植肾功能丧失的重要因素.

Objective To study the influence of HLA-II antibody to transplantation renal long term survival. Methods From early of 2007 to June, 2012, PRA tests were carried out in post-transplantation patients of 1990s, renal function （serum ere- atinine and urea nitrogen level） were observed in long term. 147 recipients showed HLA-II positive in 2007 ,then PRA tests were carried out 1~2 times each year,renal function were observed in time. PRA were detected using enzyme linked immu- nosorbent assay. Serum creatinine arid urea nitrogen level was offered by clinical laboratory. Results HLA-II antibody showed positive in 147 patients in 2007, in which 93 patients showed normal renal function and 54 patients showed renal function decreased. For 5 years continue observe （from 2007 to 2012）, 6 and 34 patients lose renal function,respectively. HLA-II antibody positive;16 and 14 patients renal function decreased,respectively. 71 renal functions showed normal and renal function recovered in 6 patients. There were significant difference between normal renal function recipients and de- creased renal function recipients in HLA-II positive patients after 5 years （Z2 =55.70,P〈0. 001）. Conclusion HLA-II an- tibody is an important factor causing graft function loss