S-KIR基因组合型与肝移植术后急性排斥发生率的关

Effects of S-KIR on acute allograft rejection after cadaveric liver transplantation

目的了解激活型NK细胞受体（S-KIR）基因组合型与肝脏移植后急性排斥反应（AR）发生率的相关性。方法采用PCR-SSP技术对56例接受异体肝脏移植的供受者进行KIR基因分型，采集受者移植前后的临床信息，采用SPSS16．0软件进行统计学分析。结果抑制型KIR（L-KIR，基因型AA）在肝移植患者中di50％（28／56），其表达频率为0．499；激活型KIR（S-KIR，基因型AB／BB）在肝移植患者中占50％（28／56），其表达频率为0．500。56例受者中有16例发生了AR，发生率28．6％，发生时间为术后7～30d，中位时间为术后14d。16例术后发生AR的患者中，受者为L-KIR者的AR发生率为18．8％（3／16），受者为S．KIR者的AR发生率为43．8％（7／16），差异无统计学意义（P〉0．05）；供者为L-KIR者的AR发生率为25．0％（4／16），供者为S．KIR者的AR发生率为12．8％（2／16），差异亦无统计学意义（P〉0．05）。在移植后发生AR的受者中表达1个KIR激活基因（SI）的占16．67％，表达≥2个KIR激活基因（s2）的占83．33％，差异有统计学意义（p〈0．05）。结论肝移植受者S-KIR组合型及其数目与术后AR的发生率存在关联。在肝移植受者中进行KIR检测，可为肝移植后小剂量、低浓度、联合抗排斥药物的临床应用提供参考。

Objective To evaluate the effect of activated killer cell immunoglobulin-like receptor （S-KIR） on acute rejection （AR） after cadaveric liver transplantation. Methods Fifty-six randomized pairs of donors and recipients of liver transplantation were investigated to define their KIR genotype with PCR-SSP method. The perioperative clinical data of recipients were collected and statistically analyzed by SPSS 16.0. Results Inhibitory KIR （L-KIR, genotype AA） accounted for 50% （28/56） in the liver transplantation patients, of whom the expression frequency was 0.499; S-KIR （genotype AB/BB） accounted for 50% （28/56）, of whom the expression frequency was 0.500. Out of the 56 pairs, AR occurred in16 recipients with an incidence of 28.6%. AR occurred 7-30 days after operation, and the median time was 14 days. AR occurred in 18.8% （3/16） of the recipients with AA assortment and in 43.8% （7/16） with AB/BB assortment, and there was no significant difference between two groups （P〉0.05）. AR occurred in 25.0% （4/16） of the donors with AA assortment and in 12.5% （2/16） with AB/BB assortment, and there was also no significant difference between two groups （P〉0.05）. AR occurred in 16.67% of the recipients who expressed one activating KIR gene （S1）, and in 83.33% of the recipients who expressed two or more than two activating KIR genes （$2）, with significant difference between two groups （P〈0.0S）. Conclusions The genotype assortment and number of S-KIR may be related to the AR occurrence after liver transplantation. KIR tests of recipients may have significant clinical value in research of the effect of low-dose, low concentration, and combined therapy with anti-rejection drugs after liver transplantation.