血管紧张素Ⅱ1型受体自身抗体与致敏肾移植受者预后相关性研究

Correlation between anti-angiotensin type 1 receptor antibody and prognosis of sensitized renal transplant recipients

目的探讨作为非HLA抗体的血管紧张素Ⅱ1型受体（AT1R）自身抗体与HLA抗体阳性的致敏肾移植受者预后的相关性。 方法检测43例HLA抗体阳性的致敏肾移植受者的AT1R抗体水平。HLA抗体检测方法采用Luminex单抗原微珠分析，通过ELISA方法进行AT1R抗体水平的检测；根据AT1R抗体水平高低将43例患者分为AT1R抗体阳性组（AT1R抗体≥9 U/ml，12例）及AT1R抗体阴性组（AT1R抗体〈9 U/ml，31例），分别检测两组患者移植后的排斥反应及移植物功能丧失发生率、HLA抗体水平、肾功能、肾存活率及受者存活率等。结果AT1R抗体阳性组及AT1R抗体阴性组的移植物功能丧失率分别为41.7%（5/12）及9.6%（3/31），两组比较，差异有统计学意义（P＝0.02）；两组的AMR发生率分别为25%（3/12）及0%（0/31），两组差异有统计学意义（P＝0.03）；AT1R抗体阳性组患者1年存活率低于AT1R抗体阴性组（P〈0.05）；AT1R抗体（AT1RAA＝8.7 U/ml）与单抗原微珠分析的MFI（MFI＝9 119）之间无明显相关性。AT1R抗体是致敏肾移植受体抗体介导急性排斥反应及移植肾功能丧失的危险因素。结论可通过监测AT1R抗体水平指导移植术后受者的治疗。这一新发现为排斥反应的防治提供了新途径。

ObjectiveTo evaluate the correlation between anti-angiotensin type 1 receptor （AT1R） antibody and the prognosis of HLA-positive sensitized renal transplant recipients.MethodsForty-three HLA-positive sensitized recipients positive for AT1R antibodies were tested. HLA antibodies were tested by Luminex-based single antigen beads assay. AT1R antibody was detected by ELISA. The patients were divided into two groups according to AT1R antibody level： AT1R-AA positive group （AT1R-AA ≥9 U/mL, n=12） and AT1R-AA negative group （AT1R-AA〈9 U/mL, n=31）. We also analyzed the rate of rejection and allograft loss, HLA antibodies level, kidney function, kidney survival and patients’ survival, etc.ResultsThe rate of allograft loss in the AT1R-AA positive group and the AT1R-AA negative group was 41.7% （5/12） and 9.6% （3/31） respectively （P=0.02）. The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25% （3/12） and 0.0% （0/31） respectively （P=0.03）. Meanwhile, the one-year-patients＇ survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group （P〈0.05）. There was no significant association between AT1R-AA （mean AT1R-AA=8.7 U/mL） and MFI （mean MFI=9119）. AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.ConclusionThe rate of allograft loss in the AT1R-AA positive group and the AT1R-AA negative group was 41.7% （5/12） and 9.6% （3/31） respectively （P=0.02）. The rate of AMR in the AT1R-AA positive group and the AT1R-AA negative group was 25% （3/12） and 0.0% （0/31） respectively （P=0.03）. Meanwhile, the one-year-patients＇ survival in the AT1R-AA positive group was lower than in the AT1R-AA negative group （P〈0.05）. There was no significant association between AT1R-AA （mean AT1R-AA=8.7 U/mL） and MFI （mean MFI=9119）. AT1R antibody was one of risk factors to acute antibody-mediated rejection and kidney allograft loss for sensitized recipients.