两种配型标准在壮族肾移植患者配型中的应用效果对比

Comparison of efficacy between two matching standards applied to kidney transplantation patients with Zhuang nationality

目的比较人类白细胞抗原(HLA)氨基酸残基配型(Res M)及六抗原无错配标准抗原配型(0Ag MM)标准在壮族肾移植患者配型中的应用效果。方法回顾性分析225例壮族肾移植术后患者的配型资料,按0Ag MM标准,分为0～2个抗原错配(0～2 MM)、3～4个抗原错配(3～4 MM)、5～6个抗原错配(5～6 MM),按Res M标准分为0～2个残基错配(0～2 MM)和3～4个残基错配(3～4 MM)。比较两种标准下的错配情况、患者术后急性排斥反应发生率及移植肾功能延迟恢复(DGF)发生率。结果 0Ag MM标准配型的3～4 MM比例高于Res M标准,而0～2 MM比例低于Res M标准(P <0. 05)。0Ag MM标准与Res M标准的0～2 MM组、3～4 MM组急性排斥反应发生率及移植肾DGF发生率比较,差异均无统计学意义(均P>0. 05)。在0Ag MM标准下,5～6 MM组、3～4 MM组、0～2 MM组急性排斥反应发生率及移植肾DGF发生率均依次降低(均P <0. 05);在Res M标准下,3～4 MM组急性排斥反应发生率及移植肾DGF发生率均高于0～2 MM组(均P <0. 05)。结论与按0Ag MM标准比较,按照Res M标准进行配型能提高肾移植供-受者HLA相配的概率,但不增加移植肾急性排斥及移植肾DGF的发生,这种配型策略亦适用于我国壮族人群肾移植。

Objective To compare the efficacy between human leukocyte antigen(HLA)amino acid residue matching(Res M)and zero HLA-A,B,DR,antigen mismatch(0 Ag MM)standards applied to kidney transplantation patients with Zhuang nationality.Methods Matching data of 225 patients with Zhuang nationality after kidney transplantation were retrospectively analyzed.The cases were divided into 0-2 MM(0-2 antigen mismatches)group,3-4 MM(3-4 antigen mismatches)group and 5-6 MM(5-6 antigen mismatches)group according to 0Ag MM standard.The cases were divided into 0-2 MM(0-2 residue mismatches)group and 3-4 MM(3-4 residue mismatches)group according to Res M standard.The mismatch,incident rate of postoperative acute rejection and delayed graft function(DGF)rate of grafted kidney were compared between the two standards.Results Compared to the Res M standard,the proportion of 3-4 MM was higher and the proportion of 0-2 MM was lower when matching by the 0 Ag MM standard(P<0.05).In the 0-2 MM group or 3-4 MM group,there were no statistical differences in the incident rate of postoperative acute rejection and DGF rate of grafted kidney between the 0 Ag MM standard and the Res M standard(all P >0.05).Under the 0 Ag MM standard,the incident rate of postoperative acute rejection and DGF rate of grafted kidney decreased in the order of 5-6 MM group,3-4 MM group and 0-2 MM group(all P<0.05).Under the Res M standard,the incident rate of postoperative acute rejection and DGF rate of grafted kidney decreased in the 3-4 MM group were higher than those in the 0-2 MM group(P<0.05).Conclusion Compared to the 0Ag MM standard,matching by the Res M standard can increase the probability of donor-recipient HLA matching in kidney transplantation,without increasing the incidence of postoperative acute rejection and DGF of grafted kidney.This matching strategy is also applicable for the Zhuang people undergoing kidney transplantation in China.