肾移植术后新生抗内皮细胞抗体与术后不良事件的相关性

Correlation between de nove anti-endothelial cell antibodies and postoperative adverse events after renal transplantation

目的 探讨肾移植术后新生抗内皮细胞抗体（AECA）与不良事件的相关性及术后半年内移植肾功能的影响.方法 采用间接免疫荧光法（ⅡF）检测85例受者术前及术后1d、3d、7d、15d及1个月血清AECA的表达情况,并根据AECA检测结果将受者分为双阳性组（术前和术后AECA阳性）、单阳性组（术后新生AECA阳性）和阴性组（术前和术后AECA阴性）.统计各组不良事件的发生情况,不良事件包括移植物功能恢复延迟（DGF）、排斥反应、感染等,记录各组受者术后半年内各时间点血肌酐水平.结果 85例受者中,29例受者AECA阳性,其中双阳性组19例,单阳性组10例,阴性组56例.单阳性组、双阳性组、阴性组术后排斥反应的发生率分别为30％、5.3％和17.9％,单阳性组高于其他两组,但差异均无统计学意义（P=0.21）;3组DGF发生率分别为70.0％、26.3％和32.1％,单阳性组显著高于其他两组,差异均有统计学意义（P=0.04）,且DGF持续时间均较其他两组明显延长（P＜0.01）;术后3组间感染发生率分别为20.0％、21.1％和8.9％,3组差异均无统计学意义（P=0.31）.与双阳性组和阴性组比较,单阳性组受者术后1周、1个月、3个月、6个月时的血肌酐水平均显著升高（P=0.02、P=0.04、P=0.04、P=0.02）.结论 肾移植术后新生AECA能够增加术后DGF发生的风险,延长DGF持续时间,影响术后半年内移植肾功能的恢复.

Objective To investigate the correlation between de nove anti-endothelial cell antibodies （AECA） and adverse events after renal transplantation and the effect of transplanted renal function within six months after operation.Methods The expression of AECA in serum of 85 renal transplant recipients was detected by indirect immunofluorescence assay （ⅡF） before and 1 day,3 days,7 days,15 days and 1 month after renal transplantation.The patients were divided into double positive group （AECA positive before and after surgery）,single positive group （postoperative de nove AECA positive） and negative group （preoperative and postoperative AECA negative） according to AECA test results.The occurrence of adverse events in each group such as DGF,rejection,infection and so on,as well as the serum creatinine levels were recorded at each time point within six months.Results Of the 85 recipients,29 were positive for AECA,including 19 in the double positive group,10 in the single positive group,and 56 in the negative group.The incidence of rejection in single positive group （30%） was higher than that in the rest two groups （5.3% for double positive group,and 17.9% for negative group）,but there was no statistically significant difference （P =0.21）.The incidence of DGF in the single positive group,double positive group and negative group was 70.0%,26.3 % and 32.1 % respectively.The positive rate of the single positive group was significantly higher than that of the rest two groups （P =0.04）,and the duration of DGF was significantly longer in the single positive group than that of the rest two groups （P〈0.01）.The incidence of infection in the single positive group,double positive group and negative group was 20.0%,21.1% and 8.9%respectively,and there was no significant difference among the three groups （P =0.31）.As compared with the double positive group and the negative group,the serum creatinine level was significantly increased in the single positive group at 1st week,1st month,3rd month and 6th month after operation （P =0.02,P =0.04,P =0.04 and P =0.02 respectively）.Conclusion Postoperative AECA can increase the risk of DGF,prolong the duration of DGF,and affect the recovery of renal function within 6 months after renal transplantation.