葡萄球菌蛋白A吸附治疗对群体反应性抗体水平的影响

The effect of staphylococcal protein A adsorption therapy on the panel reactive antibody

目的 研究葡萄球菌蛋白A(StaphylococcalProteinA .SPA)吸附治疗对群体反应性抗体 (PRA)水平的影响。方法 采用SPA吸附系统对 32例等待肾移植的致敏受者进行体外吸附实验、体内吸附实验和临床移植观察。结果 ①单次SPA吸附治疗可处理循环血浆 4 5 0～ 6 0 0ml;其饱和吸附的IgG量为 (3.98±0 .5 1)g ;实验终点饱和吸附的IgG量 (M1)为 (19.5 4± 3.13)g/L ,吸附后血浆IgG(M2 )水平降低 5 1.2 % ;②本组体内吸附实验前 ,PRA为 98%～ 5 1%者 5例 ,PRA为 5 0 %～ 4 0 %者 15例 ,PRA为 39%～ 2 5 %者 12例。每次SPA吸附治疗的循环血浆量为 70 0 0～ 90 0 0ml。本组经 (6 .70± 3.11)次SPA吸附治疗后 ,2 9例 (占90 .6 2 % )PRA降至 <12 % ;③ 2 7例 (83.37% )顺利地接受肾移植手术。术后未发生超急或急性排斥反应 ,肾功能均得以恢复。结论 SPA吸附治疗可降低致敏患者体内预存的PRA水平。SPA吸附治疗辅以配型良好的肾脏及新型免疫抑制剂 ,对预防和减轻肾移植后排斥反应疗效确切。

Objective To evaluate the effect of staphylococcal protein A(SPA)adsorption therapy on panel reactive antibody(PRA). Methods The experiment of SPA adsorption-system was carried out in vitro and in vivo for 32 sensitive recipients [Population reactive antibody (PRA)>25%] patients and clinical kidney transplantation of these patients were observed.Results ①About 450～600ml blood plasma was given out in one SPA adsorption treatment. The mean levels of IgG adsorbtion saturated was (3.98 ± 0.51)g/L; at the end of the experiment the mean level was (19.54 ± 3.13)g/L. The levels of plasma IgG after absorption was decreased by 51.2%; ②Before SPA adsorption therapy,the levels of PRA were: 98%～51% for 5cases、 50%～40% for 15 cases and 39%～25% for 12 case. After (6.70± 3.11)times SPA adsorption therapy, the PRA levels decreased to lower than 12% in 29 patients(90.62%)and 7 000～9 000ml circulated plasma involved in every SPA adsorption therapy.③Twenty-seven cases(83.37%)accepted kidney transplantation, no serious rejection occurred and all recovered. Conclusions To sensitive patients, the levels of PRA could be reduced by the SPA adsorption therapy which had a definitely therapeutic effects on the acute rejections following renal transplantation if combined with better HLA matching model of kidney and new type immunosuppressants.