血管紧张素Ⅱ1型受体自身抗体在移植肾功能恢复延迟发生和发展中的作用

Angiotensin Ⅱ type 1 receptor agonistic antibodies enhance acute ischemic tubular injury in patients subject to kidney transplantation

目的评价血管紧张素Ⅱ1型受体自身抗体（AT1-AA）对移植肾功能恢复延迟（DGF）发生和发展的影响。方法回顾性研究2010年1月至2012年12月间139例。肾移植受者的临床资料，采用酶联免疫吸附法测定AT1-AA血清结合水平。根据AT1-AA水平将DGF受者分为AT1-AA高结合力组（研究组，11例）及AT1-AA低结合力组（对照组，23例），对两组受者的临床资料、实验室数据及组织学特性进行分析，观察AT1-AA对DGF的发生及转归的影响。结果139例受者中，24例为AT1-AA阳性，115例为阴性；术后共有34例发生DGF，发生率为24．5％（34／139），其中AT1-AA阳性受者的DGF发生率为45．8％（11／24），AT1-AA阴性受者为20．O％（23／115），二者比较，差异有统计学意义（P〈0．05）。此外，与对照组比较，研究组受者接受肾脏替代治疗的时间较长[（59±32）个月和（47±26）个月，P〈0．05）]、肾动脉阻力指数更高（0．80±0．10和0．72±0．10，P〈0．05）及急性肾小管损伤（2．7±0．5比1．8±1．1，P〈0．05）／急性肾小管坏死（0．9±0．5比0．5±0．3，P〈0．05）较为严重。1年随访结果显示，两组移植肾存活率无明显差异（90．9％比95．7％，P〉0．05）。结论自身高结合力AT1-AA在DC-F的发生和发展过程中起重要的作用。

Objective To evaluate the impact of autoantibodies to angiotensin Ⅱ type 1 receptor AT1-AA on clinic outcomes of delayed graft function （DGF） grafts. Method We reviewed the records of all 139 consecutive adult recipients who received single kidney transplantation and clinical management between Jan. 2010 and Dec. 2012 in our centre. The serum levels of AT1-AA were measured by a streptavidin-enzyme-linked immunosorbent assay. All patients with DGF were enrolled in this study and divided into two groups： （1） AT ＋ DGF group （serum AT1-AA positive, 11 cases） ; （2） AT-DGF group （serum AT1-AA negative, 23 cases）. All clinical and laboratory data were recorded in our transplant database system at each visit. Result 139 recipients were enrolled. The overall presence of DGF was 24. 5% （34/139）. The incidence of DGF in patients with high binding ATI-AA was significantly higher than that in those with low binding of AT1-AA （11/24 vs. 23/115, 45.8% vs. 20. 0%, P〈0. 05）. In addition, longer duration of renal replacement therapy （59 ± 32 vs. 47 ±26 months, P〈0. 05）, higher resistance index （0. 80 ± 0. 10 vs. 0. 72 ± 0. 10, P〈0. 05） of allografts and more severe acute tubular injury （2. 7 ± 0. 5 vs. 1.8 ± 1.1, P%0. 05）/acute tubular necrosis （0. 9 ± 0. 5 vs. 0. 5 v 0. 3, P〈0. 05） were observed in AT ＋ DGF group than in AT-DGF group. One-year graft survival and death censored graft survival were similar between two groups （90. 9% vs. 95.7%, P 〉 0. 05 ）. Conclusion Presence of high binding anti-AT1 receptor had detrimental impacts on initiation and development of DGF.