摘要
[目的]探讨人类自细胞抗原(HLA)氨基酸残基配型(Res M)在免疫致敏尤其是高敏受者肾脏移植中的临床意义。[方法]对47例致敏受者采用酶联免疫吸附法(ELUSA)检测体内预存的群体反应性抗体-IgG(PRA-IgG)的水平及特异性;采用一步法单克隆抗体技术和微量序列特异性引物聚合酶链反应(Micro-PCR-SSP)技术进行HLA Ⅰ类和Ⅱ类分型。[结果]47例致敏受者的PRA-IgG水平为8.3％-96.4％,平均为38.8％,供受者间按传统的HLA抗原错配(MM)原则,0-1错配(MM)、2 MM的患者分别为5例(10.6％)、9例(19.1％),而按Res M的原则,0-1 MM、2 MM患者分别提高到22例(46.8％)、17例(36.1％)(P<0.001);其中PRA≥50％的18例高敏受者中,0-1MM 13例(72.2％),而PRA<50％的29例受者中,0-1MM 9例(31％),两者间差异有统计学意义(P<0.001);47致敏受者肾移植术后3个月内排斥反应的发生率为35％,在18例PRA≥50％的高敏受者中,仅有4例(22.2％)发生排斥反应,29例PRA<50％的受者中,11例(37.9％)发生排斥反应(P>0.05).[结论] HLA氨基酸残基配型可显著提高供受者的相配率,良好的HLA配型对减少高敏受者肾移植的排斥反应、提高移植物的存活率具有重要意义。
[Objective] To investigate the clinical implication of human leucocyte antigen(HLA) matching in sensitized recipients of renal transplantation. [ Methods ] 47 sensitized recipients' preexisting panel reactive antibody IgG(PRA- IgG) was detected by enzymed-linked immunosorbent assay (ELISA) with Lambda Antigen Tray. Donor and recipients HLA class Ⅰ and Ⅱ typing was performed by one-step monoclonal antibody and micro polymerase chain reaction with sequence-specific primers (Micro-PCR-SSP). [Results] PRA- IgG positive rate in 47 sensitized recipients was between 8, 3% -96. 4% with an average of 38. 8% . Patients with 0-1,2 mismatch (MM) of HLA-A, B, DR antigen were 5 (10. 6%)、9 (19. 1% ) respectively according to the standard of conventional HLA antigen matching. Whereas patients with 0-1, 2 mismatch of HLA amino acid residue were 22(46. 8% )、17 (36. 1% ) respectively by the rule of HLA amino acid residue matching and the cases of 0-1 MM increased 36. 2% ( P < 0. 001) . In the 18 highly sensitized (PRA≥50% ) recipients, patients with 0-1MM were 13(72. 2% ), whereas patients with 0-1MM were 9(31% ) in the mild sensitized (PRA < 50% ) recipients, there are significant difference in the two groups( P < 0. 001). The rejection rate was 35% of the 47 sensitized patients in 3 months after renal transplantation. In the 18 highly sensitized patients(PRA≥50% ), 4(22. 2% ) patients occurred rejection, as a control in the 29 mild sensitized (PRA < 50% ) recipients, 11 (37. 9% ) patients occurred rejection( P > 0. 05). [Conclusion] The allocation based on HLA amino acid residue matching should result in a significantly higher percentage of well-matched between donors and recipients. Good HLA matching plays an important role in reducing the incidence of rejection and improving the survival of grafts in highly sensitized patients.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2004年第1期70-73,共4页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省科技青年基金资助项目(960131)
广东省重点攻关基金资助项目(97011)
关键词
肾移植
HIJA抗原
组织相容性试验
氨基酸残基
配型
kidney transplantation
HLA antigens
histocompatibility testing
amino acid residue
matching
