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目的分析肾移植术后抗人类白细胞抗原(HLA)抗体监测和移植肾穿刺病理学检查早期诊断抗体介导的排斥反应(AMR)的必要性。方法筛选51例术后产生新生供体特异性抗体(dn DSA)的受者,检测供体特异性抗体(DSA)及其结合C1q的能力,同时进行移植肾穿刺病理诊断。对于符合AMR诊断的受者,比较分析移植肾功能不稳定组和稳定组受者的DSA类别、补体结合能力和移植肾病理组织Banff评分。对无排斥反应组、移植肾功能不稳定组和稳定组受者的移植物进行Kalan-Meier生存分析。结果在移植肾功能不稳定组和稳定组受者中,HLA抗体的不同类别、DSA的平均荧光强度(MFI)值、补体相关检测C1q结合力和C4d管周毛细血管沉积情况差异均无统计学意义(均为P>0.05)。在组织形态学损伤方面,两组在微血管炎、动脉内膜炎、肾小管-间质炎、移植肾小球病、肾小管萎缩-间质纤维化等表现的Banff评分差异均无统计学意义(均为P>0.05)。移植肾功能不稳定组受者移植物累积存活率显著低于稳定组,稳定组明显低于不符合排斥病理诊断的受者(P=0.002)。结论肾移植术后定期监测抗HLA抗体和做移植肾病理穿刺检查非常必要,有助于早期发现和诊断AMR。
Objective To analyze the necessity of early detection of antibody-mediated rejection (AMR) after anti-human leukocyte antigen (HLA) antibody monitoring and renal biopsy pathology in renal transplant recipients. Methods Fifty - one patients with postoperative neonatal donor - specific antibody (dn DSA) were screened for the ability of donor - specific antibody (DSA) and its binding to C1q, and pathological diagnosis of renal allograft was performed. For recipients eligible for AMR, the DSA class, complement fixation capacity, and graft-versus-graft pathology were compared between the transplant-stable and stable transplant recipients. Kalan-Meier survival analysis was performed on grafts without rejection, grafts of renal allograft and stable recipients. Results There was no significant difference in the different categories of HLA antibodies, mean fluorescence intensity (MFI) of DSA, complement-related detection of C1q binding capacity and C4d perivascular capillary deposition in transplanted renal dysfunction group and stable group recipients Significance (all P> 0.05). In histopathological damage, there was no significant difference in the Banff scores between the two groups in microvascitis, endarteritis, tubulointerstitial disease, glomerulonephritis, tubulointerstitial fibrosis (All P> 0.05). The graft survival rate in transplant recipients with unstable renal function was significantly lower than that in stable group, and significantly lower in stable group than those without pathological diagnosis (P = 0.002). Conclusion It is very necessary to monitor anti-HLA antibodies regularly after renal transplantation and pathological examination of renal grafts. It is helpful for the early detection and diagnosis of AMR.