等待肾移植患者体内预存HLA抗体特点及致敏因素分析

Characteristics of panel reactive antibodies in patients waiting for kidney transplantation and analysis of sensitization factors

目的分析研究等待肾移植手术的患者体内预存群体反应性抗体(PRA)特点及其产生原因。方法采用酶联免疫吸附法(ELISA)检测1 618名等待肾移植患者PRA,根据患者原有的输血史、妊娠史和移植史,将其分为5组:未输血未妊娠组(n=804);单纯输血组(n=330);单纯妊娠组(n=229);输血合并妊娠组(n=196);有移植史组(n=59)。结果 1 618名等待肾移植患者中,未输血未妊娠组、单纯输血组、单纯妊娠组、输血合并妊娠组和有移植史组PRA阳性率分别为5.97%、18.18%、22.71%、48.47%和76.27%。患者出现频率较高的HLAⅠ类抗体有抗-A2、-A23、-A66和-B7等,HLAⅡ类抗体有抗-DR52、-DR53、-DQ5和-DQ6等。有移植史组患者产生DR53和DR52抗体的频率较高,占HLAⅡ类抗体总数的19.32%。结论不同个体对相同致敏因素反应不同;在相同致敏因素存在的情况下,男性和女性患者PRA阳性率差异无统计学意义;输血史、妊娠史和移植史可协同提高致敏率;抗体产生的频率与抗原频率分布不相一致;HLAⅡ类抗体中,DR52和DR53抗体的产生与移植物失功存在一定关联性。

Objective To investigate the characteristics of panel reactive antibodies （PRA） and the sensitization factors in patients waiting for kidney transplantation. Methods PRA tests were performed by the method of ELISA and 1618 patients waiting for kidney transplantation were tested. Patients were divided into five groups, according to their history of transfusion, pregnancy and transplantation. Group A：804 patients with neither transfusion nor pregnancy history;group B：330 patients with mere transfusion history;group C ：229 patients with mere pregnant history;group D：196 patients with both transfusion and pregnant history; group E：59 patients with transplantation history. Results PRA positive rate was 5.97%,18. 18% ,22.71% ,48.47% and 76. 27% in group A,group B, group C, group D and group E respectively. Some antibodies of human leukocyte antigen （HLA） had higher frequency, including antibodies such as HLA-A2, A23, A66, B7, DR52, DP,.53, DQ5 and DQ6. The antibodies of DR52 and DIL53 had a high frequency in the patients with transplantation history and the frequency was 19. 32% of the total HLA- Ⅱ antibodies. Conclusion Different individuals with the same allergenic factors had different sensitivity;with the same allergenic factors, the PRA positive rate of male and female patients had not significantly differenc; Transfusion, pregnancy and transplantation had synergy effect and could increase the sensitization rate together; Anti- body frequencies and the distributions of antigens were not consistent ; The production of DR52 and DR53 antibodies had a certain relevance with the graft dysfunction.