肾移植术后肌酐升高出现AMR患者HLA抗体和非HLA抗体阳性的危险因素分析

Analysis of risk factors for positive HLA and non-HLA antibodies in AMR patients with creatinine elevation after renal transplantation

目的分析肾移植术后肌酐升高出现抗体介导的排斥反应(AMR)患者人白细胞抗原(HLA)抗体和非HLA抗体阳性的危险因素。方法选择2021年9月—2023年9月本院收治的62例肾移植术后肌酐升高出现AMR患者作为研究对象,统计其人口学资料、病史和合并症并获取临床资料。同时均进行HLA抗体检测和非HLA抗体Panel检测,其中HLA抗体、非HLA抗体均阳性定为双阳组,非HLA抗体阳性定为单阳组。分析肾移植术后肌酐升高出现AMR患者HLA抗体和非HLA抗体阳性的危险因素。结果Panel检测发现:HLA抗体、非HLA抗体均阳性者28例,非HLA抗体阳性者34例。术后时间、肾小球肾炎、高血压、肾功能指标、T细胞亚群水平是肾移植术后肌酐升高出现AMR患者HLA抗体和非HLA抗体阳性的影响因素(P<0.05)。经Logistic回归分析,术后时间>1年、尿素氮(BUN)水平≥9 mmol/L、血肌酐(SCr)水平≥110μmol/L、胱抑素C(CysC)水平≥1.5 mg/L、CD3^(+)T细胞亚群水平<45%、CD4^(+)T细胞亚群水平<33%、CD8^(+)T细胞亚群水平≥34%为肾移植术后肌酐升高出现AMR患者HLA抗体和非HLA抗体阳性的独立危险因素。结论术后时间越长,病史为肾小球肾炎,合并症为高血压,肾功能越差,体液免疫功能越差与肾移植术后肌酐升高出现AMR患者HLA抗体和非HLA抗体阳性密切相关。

Objective To analyze the risk factors for positive human leukocyte antigen(HLA)antibodies and non-HLA antibodies in patients with antibody-mediated rejection(AMR)following renal transplantation and creatinine elevation.Methods A total of 62 patients with AMR post-renal transplantation with creatinine elevation admitted to Zhengzhou Seventh People's Hospital from September 2021 to September 2023 were selected.Demographic data,medical histories,and comorbidities were statistically analyzed,and clinical data were obtained.Both HLA and non-HLA antibodies were tested using a Panel,with both HLA and non-HLA antibodies positive defined as the double-positive group,and non-HLA antibodies positive defined as the single-positive group.The risk factors for positive HLA and non-HLA antibodies in AMR patients with creatinine elevation after renal transplantation were analyzed.Results Panel testing revealed 28 cases positive for both HLA and non-HLA antibodies,and 34 cases positive for non-HLA antibodies.Postoperative time,glomerulonephritis,hypertension,renal function indicators,and T cell subsets were influential factors for positive HLA and non-HLA antibodies in AMR patients with creatinine elevation after renal transplantation(P<0.05).Logistic regression analysis identified postoperative time>1 year,blood urea nitrogen(BUN)level≥9 mmol/L,serum creatinine(SCr)level≥110μmol/L,cystatin C(CysC)level≥1.5 mg/L,CD3^(+)T cell subset level<45%,CD4^(+)T cell subset level<33%,and CD8^(+)T cell subset level≥34%as independent risk factors for positive HLA and non-HLA antibodies in AMR patients with creatinine elevation after renal transplantation.Conclusions The longer postoperative time,a history of glomerulonephritis,comorbidity of hypertension,poorer renal function,and weaker humoral immune function are closely associated with positive HLA and non-HLA antibodies in AMR patients with elevated creatinine after renal transplantation.