摘要
目的 探讨人类白细胞抗原 (HLA)群体反应性抗体 (PRA)对肾脏移植效果的影响。方法 采用酶联免疫吸附法 (ELISA)和微量补体依赖性细胞毒试验 (CDC)对 897例次肾移植受者的PRA进行动态监测。结果 85 6例初次肾移植受者中术前PRA阳性者 12 1例 ,占 11% ,而 33例次 2次移植和 8例次 3次移植受者术前PRA阳性分别为 5 8%和 87% ,与初次肾移植受者组比较 ,PRA阳性受者比例均显著增高 (P <0 .0 0 1)。PRA阳性组受者肾移植术后排斥发生率为 40 % ,而阴性组受者仅 17% ,两组比较差异有显著性 (P <0 .0 0 1)。PRA阳性组受者的移植物存活率则明显低于阴性组 (P <0 .0 0 1) ,尤其是PRA >40 %的高致敏受者的 1、3、5年和 7年移植物存活率与阴性组比较分别下降了 2 4%、38%、5 7%和 5 6 % ,均为P <0 .0 0 1。ELISA法与CDC法的双盲试验发现 ,319份受者血清中CDC PRA的假阳性和假阴性率分别为 3 .8%和 3 .1%。结论 PRA是预测受者致敏状态的敏感指标 。
Objective To investigate the effect of HLA specific antibodies, population reactive antibody (PRA), on the outcome of renal allografts. Methods Serum PRA in the recipients with 897 case/times of renal transplantation was determined by using enzyme linked immunosorbent assay (ELISA) with lambda antigen tray (LAT) and complement dependent lymphocytotoxicity (CDC) techniques with lambda cell tray (LCT) to compare their specificity and sensitivity. Results There were 121 recipients with positive PRA in 856 recipients of primary renal transplantation with the positive rate being 11?%. PRA positive rate of the recipients in the 33 cases of second renal transplant and 8 cases of third renal transplant was 58?% and 87?% respectively (both P < 0.001 ). Rejection rate of renal post transplantation in the positive PRA recipients was 40?% and only 17?% in the negative PRA recipients ( P < 0.001 ). Graft survival rate was decreased significantly in the positive PRA group, especially in the highly sensitized recipients with PRA> 40?% the graft survival rate at 1 , 3 , 5 , and 7 years were decreased by 24?% , 38?% , 57?% and 56?% respectively as comparing with that in the negative PRA group (all P < 0.001 ). False positive rate and false negative rate of CDC PRA in 319 serum samples were 3.8 ?% and 3.1 ?% respectively by blindly determination of PRA using ELISA compared with CDC techniques. Conclusion PRA determination was a sensitive indictor predicting the sensitivity status of the recipients and there were significant influence on graft survival and rejections.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2001年第2期103-105,共3页
Chinese Journal of Organ Transplantation
关键词
人类白细胞抗原
群体反应性抗体
肾移植
排斥反应
Human leukocyte antigens
Population reactive antibodies
Renal transplantation
