摘要
目的评价肾移植术后特异性人类白细胞抗原(HLA)-Ⅱ类抗体对移植肾长期存活的影响。方法采用前瞻性队列研究,通过酶联免疫吸附(ELISA)法检测118例。肾移植患者围手术期特异性 HLA-Ⅱ类抗体水平,随访观察抗体对移植肾长期存活的影响。结果 (1)生存分析提示HLA-Ⅱ类抗体阳性组第3、第4年移植肾存活率明显低于抗体阴性组(第3年:78.6% vs 84.4%,第4年:71.4% vs 80.0%,P=0.002);排除受者死亡因素后,HLA-Ⅱ类抗体阳性组移植肾存活率仍然低于抗体阴性组(第3年:85.7% vs 92.2%,第4年:82.1% vs 90.O%,P=0.003)。(2)HLA-Ⅱ类抗体阳性组患者第3、第4年移植肾功能下降的比例高于抗体阴性组(第3年:39.3% vs 33.3%,第4年:46.4% vs 38.9%,P=0.001)。(3)HLA-Ⅱ类抗体阳性组和阴性组比较,晚期急性排斥发生率的差异无统计学意义(10.7% vs 13.3%,P>0.05)。结论术后特异性 HLA-Ⅱ类抗体可能是影响移植肾长期存活的的重要因素之一,移植后 HLA-Ⅱ类抗体水平的动态变化可以从一个侧面反映移植肾的预后情况。
Objective To evaluate the clinic relevance of anti-HLA- Ⅱ antibodies on allograft longterm survival. Methods Perioperative sera of 118 cadaveric kidney recipients were tested by ELISA for anti- HLA- Ⅱ antibodies in our prospective cohort study. All recipients who divided into different groups according to HLA antibody production were followed-up. Results （ 1 ） Anti-HLA- Ⅱ antibody-positive recipients were associated with significantly lower graft survival（78. 6% vs 84. 4% ; 71.4% vs 80.0% ; P =0. 002） and death-censored graft survival （ 85.7% vs 92. 2% ; 82. 1% vs 90. 0% ; P = 0. 003 ） at 3 and 4 years compared to antibody-negative recipients. （2） Anti-HLA-Ⅱ antibody-positive recipients were associated with a significantly increased risk for decline in renal function at 3 and 4 years（39. 3% vs 33.3% ; 46.4% vs 38.9% ,P = 0. 001 ）. （3） There was statistically non-significance difference in late-acute rejection rate between two groups （ 10.7% vs 13.3%, P 〉 0. 05 ）. Conclusion Posttransplant HLA-Ⅱ antibodies perhaps are one of the most important influential facts on allograft long-term survival and could be used to predict the prognosis of allograft.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第28期1978-1980,共3页
National Medical Journal of China
关键词
肾移植
预后
HLA-Ⅱ类抗体
Kidney transplantation
Prognosis
HLA- Ⅱ antibody
