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目的了解肾移植前输血与群体反应性抗体(PRA)增高的关系。方法随机选择2004年1月~2005年5月吉林大学中日联谊医院肾移植与血液净化中心不同原因所致尿毒症的肾移植前患者206例,按输血与未输血分组。206例均采用美国One Lambda公司ELISA法试剂盒检测PRA。对PRA阳性成因进行分析,判定输血与PRA阳性的相关性。结果本组观察病例中PRA阳性为28例,PRA水平为5.1%~90%不等,占观察病例13.59%,输血组PRA阳性比率为31.25%(15/48)明显高于未输血组8.23%(13/158),差异有统计学意义(P<0.05)。男、女致敏率分别为9.17%(11/120)和19.77%(17/86),差异有统计学意义(P<0.05);透析时间1年以上和l年以内的致敏率分别为14.1%(11/78)和13.28%(17/128),两者差异无统计学意义(P>0.05);妊娠史和无妊娠史的致敏率分别为24.24%(16/69)和5.88%(1/17),差异有统计学意义(P<0.01),有移植史者和无移植史者的致敏率分别为72.72%(8/11)和8.72%(17/195),两者差异有统计学意义(P<0.01)。结论器官移植前多次输血是造成HLA致敏抗体阳性的主要因素,应尽量减少移植前的输血。
Objective To understand the relationship between the blood transfusion before renal transplantation and the increase of group reactive antibody (PRA). Methods A total of 206 pretransplant patients with uremia due to various causes of renal transplantation and blood purification center of Sino-Japanese Friendship Hospital of Jilin University from January 2004 to May 2005 were randomly selected and divided into two groups: transfusion group and non-transfusion group. 206 cases were detected by the US One Lambda ELISA kit PRA. The positive causes of PRA were analyzed to determine the correlation between blood transfusion and PRA positive. Results The positive rate of PRA in this group was 28 cases and the PRA level was 5.1% ~ 90%, accounting for 13.59% of the observed cases. The positive rate of PRA in transfusion group was 31.25% (15/48), which was significantly higher than that in non-transfusion group (8.23% (13/158), the difference was statistically significant (P <0.05). The sensitivities of male and female were 9.17% (11/120) and 19.77% (17/86) respectively, the difference was statistically significant (P <0.05). The sensitivities of dialysis for more than 1 year and 1 year were 14.1% (11/78) and 13.28% (17/128), respectively. There was no significant difference between the two groups (P> 0.05). The sensitivities of pregnancy history and no pregnancy history were 24.24% (16/69) and 5.88 % (1/17), the difference was statistically significant (P <0.01). The sensitivities of patients with and without transplantation were 72.72% (8/11) and 8.72% (17/195) respectively, The difference was statistically significant (P <0.01). Conclusions Multiple transfusion of blood before organ transplantation is the main factor that causes the positive of HLA-sensitized antibody. Transfusion before transplantation should be minimized.