肾移植术后PRA与移植肾功能长期预后关系的研究

Study on the relationship between panel reactive antibody and long-term prognosis of transplant renal function

目的研究肾移植术后患者群体反应性抗体(PRA)对移植肾功能长期预后的影响。方法研究对象为首都医科大学附属北京友谊医院1994年1月至2004年12月进行肾移植手术且在术后2周左右行PRA检测并获得随访患者224例。根据肾移植术后2周左右的PRA检测结果分为阴性组(195例)和阳性组(29例)。阴性组患者于2007年再次检测PRA,两组患者于近期(2013年10月至2014年4月)检测血清肌酐(Scr),了解肾功能情况。比较PRA阳性患者(含PRA复查阳性者)和PRA阴性患者的移植肾功能长期正常率。结果阳性组患者29例,2014年4月复查18例患者肾功能丧失(17例)或下降(1例),11例患者肾功能正常。阴性组患者195例,于2007年复查PRA阴性者153例,2014年4月复查肾功能正常患者148例,肾功能下降或丧失者5例;于2007年复查PRA阳性者42例,移植肾功能均不同程度下降或丧失。2004年前PRA阳性和2007年复查PRA阳性患者共71例,2014年4月复查肾功能正常患者11例,移植肾功能长期正常率为15.5%。PRA阴性患者153例,2014年4月复查肾功能正常患者148例,移植肾功能长期正常率为96.7%。PRA阳性患者和PRA阴性患者的移植肾长期存活率比较,差异有统计学意义(P<0.005)。结论肾移植术后产生PRA对移植肾长期预后有明显影响。

Objective To study the impact of panel reactive antibody （PRA）on the long-term prognosis of transplant renal function after renal transplantation.Methods The objects of this study were 224 patients,who underwent renal transplantation,received PRA test about 2 weeks after operation and followed up in Affiliated Beijing Friendship Hospital of Capital Medical University from January 1 994 to December 2004.According to the PRA test results,the patients were divided into two groups：negative group （n =1 95）and positive group （n =29）.PRA of patients in negative group were tested again in 2007.Serum creatinine （Scr） of patients in both groups were tested recently （from October 201 3 to April 201 4）to know about the renal function.The rates of long-term normal transplant renal function between PRA positive patients （including PRA re-test positive patients）and PRA negative patients were compared.Results In 29 cases of positive group, the re-test result in April 201 4 showed that 1 8 cases were observed with loss （n =1 7）or decline （n =1 ）of renal function,and 1 1 cases were observed with normal renal function.In 1 95 cases of negative group,a total of 1 53 cases were re-tested with PRA negative in 2007,1 48 cases were re-tested with normal renal function in April 201 4,and 5 cases were observed with decline or loss of renal function.A total of 42 cases were re-tested with PRA positive in 2007 and the transplant renal function was observed decline or loss by varying degrees.There were a total of 71 cases with PRA positive before 2004 and when re-tested in 2007,and 1 1 cases were re-tested with normal renal function in April 201 4.The rate of long-term normal transplant renal function was 1 5.5%.There were 1 53 cases with PRA negative and 1 48 cases were re-tested with normal renal function in April 201 4.The rate of long-term normal transplant renal function was 96.7%.Significant difference was observed in the rates of long-term normal transplant renal function between PRA positive patients and PRA negative patients （P 〈0.005）.Conclusions PRA after renal transplantation has obvious impacts on the long-term prognosis of transplant renal function.