肾移植术后抗HLA-Ⅱ类抗体阳性患者与移植肾功能和长期存活的研究

Anti-HLA- Ⅱ antibody-positive patients with transplanted renal function and long-term survival

目的研究肾移植术后抗人类白细胞抗原（HLA）-Ⅱ类抗体阳性患者与移植肾功能和长期存活。方法对2007年在首都医科大学附属北京友谊医院已检测出抗HLA-Ⅱ类抗体阳性的肾移植术后107例患者,于2010年和2011年再次检测其抗HLA-Ⅱ类抗体,并在2014年10月前后进行肾功能和长期存活观察。结果 2007年检测出107例肾移植术后抗HLA-Ⅱ类抗体阳性患者,其中19例患者肾功能正常,2010-2011年检测仍阳性,2014年检测肾功能正常。43例患者肾功能正常,2010-2011年检测抗HLA-Ⅱ类抗体转阴性,2014年肾功能正常。2例患者肾功能正常,2010-2011年查抗体转阴性,肾功能正常,2014年肾功能下降。3例患者肾功能正常,2010-2011年查抗体转阴性,肾功能下降,2014年肾功能无再次下降趋势。18例患者肾功能正常,2010-2011年查抗HLA-Ⅱ类抗体阳性,大部分患者肾功能下降,2014年时肾功能全部下降。22例患者肾功能正常,2~3年后移植肾失功或失联。结论抗HLA-Ⅱ类抗体对移植肾功能的影响因人而异,也可能存在保护性抗体。

Objective This study focuses on the effect of anti HLA- Ⅱ antibody on kidney function and long-term survival of kidney transplantation patients. Methods A total number of 107 kidney transplantation patients from Capital Medical University Affiliated Beijing Friendship Hospital, whose anti HLA class Ⅱ antibodies had been detected to be positive and transplantation operation had been performed in 2007. In 2010-2011, these patients＇ HLA class Ⅱ antibodies were detected again. In October 2014, these patients were detected for renal function and long-term survival. Results The detection results in 2007 showed that 107 kidney transplantation patients had positive anti HLA- Ⅱ antibody. 19 patients had normal renal function with positive anti HLA- Ⅱ antibody in the detection of 2010 and 2011, and normal renal function in 2014. 43 of these patients had normal renal function but their HLA class Ⅱ antibodies turn to be negative in 2010-2011, and they had normal kidney function in 2014. There were 2 of these patients who had normal renal function with negative antibody in 2010-2011, but their renal function reduced in 2014. There were 3 patients who had renal function reduced in 2010-2011 with negative antibody, but their renal function didn＇t show downward trend in 2014. A total number of 18 patients lost most renal function in 2010-2011 with positive anti HLA- Ⅱ antibody, and lost renal function in 2014. 22 patients lost renal function or lost contact 2-3 years after renal transplantation. Conclusion The effects of anti HLA- Ⅱ antibodies on renal allograft vary from different person, and protective antibodies may exist.