液态芯片技术检测抗人类白细胞抗原抗体抗主要组织相容性Ⅰ类相关链A位点抗体在移植肾围手术期急性抗体介导性排斥反应中的应用

Luminex technique for the detection of anti HLA antibody,anti MICA antibody in kidney transplantation in peri operation period of acute antibody mediated rejection

目的探讨液态芯片技术(Luminex)检测移植肾受者围手术期发生急性抗体介导性排斥反应者抗人类白细胞抗原(HLA)抗体、抗主要组织相容性Ⅰ类相关链A位点(MICA)抗体水平与影响。方法选取我院器官移植研究所2008年1月至2013年6月肾移植术后围手术期患者106例为研究对象,采用Luminex技术检测接受同种异体肾移植手术并明确病理诊断肾围手术期急性抗体介导性排斥反应患者血清中抗HLA抗体、抗MICA抗体,并同步检测血肌酐、尿量及移植肾超声等临床指标。结果参照Banff 2007标准组织病理学诊断移植肾超急性排斥反应2例,急性抗体介导性排斥反应15例,同时应用Luminex方法检测抗HLA抗体、抗MICA抗体水平,HLA抗体检测结果15例阳性,阳性率为88%(15/17),检出PRAⅠ类和Ⅱ类阳性率分别为47%(7/15)和53%(8/15);MICA抗体2例阳性,阳性率为12%(2/17),其余89例其他病理类型检测未见抗HLA抗体、MICA抗体阳性,移植肾穿刺病理结果显示HLA抗体、抗MICA抗体阳性患者C4d沉积均为阳性。结论抗HLA抗体、抗MICA抗体可预测围手术期急性抗体介导性排斥反应发生及治疗效果,对于及时诊断及治疗排斥反应提供了一个重要指标,可影响移植肾的长期存活。

Objective To study of Luminex technique for the detection of level of anti HLA antibody ,anti MICA antibody in renal transplantation acute antibody mediated rejection in peri operation period and their influ-ence .Methods One hundred and six renal allograft biopsies were performed .All biopsies were systematically di-agnosed and evaluated according to the Banff 2007 schema .Luminex was used to detect serum anti HLA antibody , anti MICA antibody in the peri operation period of patients with acute antibody mediated rejection reaction ,and re-nal blood creatinine ,urine volume and renal ultrasound and other clinical indicators were synchronously detected . Results Two cases of hyperacute rejection and 15 cases of acute antibody mediated rejection were detected among 106 cases of renal transplantation according to histopathological diagnosis .The results showed 15 cases of HLA antibody were positive ,the positive rate was 88% ,in which positive rates of PRA Ⅰ and Ⅱ were 47% and 53% , respectively ,and 2 cases of MICA antibody were positive ,the positive rate was 12% by Luminex method .Fur-thermore ,immunohistochemical staining of C4d were also positive in these cases .While the same results were not detected in other 89 cases .Conclusion Anti HLA antibody and anti MICA antibody could be used as the impor-tant indicators to predict the occurrence and treatment effect of peri operation period of acute antibody mediated re-jection and to ensure the long-term survival of transplanted kidney .