论文部分内容阅读
目的 研究人类白细胞抗原 (HLA)配型和群体反应性抗体 (PRA)在肾移植受者 ,尤其在致敏受者的临床意义。方法 对 70例肾移植受者采用微量序列特异引物聚合酶链反应法检测HLA -I类抗原和HLA -Ⅱ类抗原 ;莱姆德细胞板通过补体依赖微量细胞毒性试验检测受者的群体反应性抗体 (PRA)。结果 (1)对 70例受者按交叉反应组配型原则 ,供、受者 0、1个位点错配分别为 10例 (14 .3% )和 2 4例 (34.3% ) ,明显高于传统HLA抗原配型结果(P <0 .0 5 ) ,术后急性排斥反应及移植肾功能延迟恢复率 ,两种配型方法间的差异无显著性。 (2 ) 70例受者中女 2 4例PRA阳性 9例 (37.5 % ) ,男 4 6例PRA阳性 5例 (10 .9% ) ,女性组明显高于男性组 (P <0 .0 5 )。 (3) 70例受者中 30例术前输血者PRA阳性 12例 (40 % ) ;4 0例无输血者PRA阳性 2例 (5 % ) ,术前输血组PRA阳性率明显高于无输血组 (P <0 .0 0 1)。 (4)PRA阳性组尤其是阳性率≥ 5 0 %的受者 ,其急性排斥发生率明显高于PRA阴性组 (P <0 .0 5 )。结论 反复输血、妊娠是PRA阳性的危险因素 ,采用交叉反应组配型和免疫吸附 ,对减少PRA阳性者肾移植排斥反应、提高移植成功率和移植物存活率具有重要意义。
Objective To study the clinical significance of human leukocyte antigen (HLA) typing and population reactive antibody (PRA) in renal transplant recipients, especially in sensitized recipients. Methods HLA-I and HLA-Ⅱ antigens were detected in 70 renal transplant recipients by polymerase chain reaction-specific polymerase chain reaction (PCR-RFLP). Lymphocyte plates were tested for their colorectal responsiveness by complement-dependent microcytotoxicity assay Antibody (PRA). Results (1) According to the matching principle of cross-reaction group in 70 patients, there were 10 cases (14.3%) and 24 cases (34.3% There was no significant difference between the two methods in traditional HLA antigen matching results (P <0.05), postoperative acute rejection and delayed graft recovery rate. (2) Among 70 recipients, 24 were PRA-positive in 9 (37.5%), 46 were PRA-positive in 5 (10.9%), and were significantly higher in female than in male (P <0.05) ). (3) PRA was positive in 30 of 70 recipients (40%) in 30 cases of preoperative blood transfusions; in 2 of 40 non-transfusion recipients (2%), the positive rate of PRA in preoperative transfusion group was significantly higher than that in non-transfused patients Group (P <0. 0 0 1). (4) The incidence of acute rejection in PRA-positive group, especially those with positive rate ≥50%, was significantly higher than that in PRA-negative group (P <0.05). Conclusions Repeated transfusion and pregnancy are the risk factors of PRA positive. Cross-reactive group matching and immunoadsorption are of great significance to reduce the rejection of PRA-positive renal transplant recipients and improve the success rate of transplantation and graft survival.