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目的研究组织相容性I类相关链A位点(MICA)基因多态性和抗MICA特异性抗体在肾移植排斥反应发生中的意义。方法采用免疫磁珠液相芯片技术对40例肾移植患者在移植术前和移植术后1个月、3个月、6个月、1年和2年动态检测抗MICA抗体的特异性和阳性分值的变化,同时采用SSOP方法分析16对肾移植供受者的MICA基因分型,并把MICA基因具有相同抗原表位的特征性分为G1组和G2组。结果在40例肾移植中尸体供肾35例,亲缘活体供肾5例。35例肾移植受者均带肾存活良好,其中33例接受动态随访。移植术前预存抗MICA抗体为12例,其中抗MICA抗体10例、抗HLA-I类+MICA抗体2例;4例分为MICA-G1组、6例分为MICA-G2组、2例共为MICA-G1和G2组。16对供受者MICA等位基因频率分布:在MICA-G1组中频率M﹡002最高,M﹡007次之;MICA-G2组中频率M﹡008最高,M﹡009和M﹡019次之。33例移植术后有4例新生抗MICA抗体,3例新生抗HLA抗体,均为抗供者特异性抗体和抗非供者特异性抗体。移植术前预存抗MICA抗体,在移植术后1～2年的动态随访中其特异性均未改变,而抗体的阳性分值呈现高低的变化。12例移植术前预存抗MICA抗体中的3例和抗体阴性1例移植术后发生急性排斥反应,临床表现为发热,尿量减少,肌酐和肾动脉阻力指数升高。33例动态随访资料显示:无论是MICA基因频率分布特点,还是抗MICA特异性抗体类型与排斥反应的关系,M﹡002、M﹡004、M﹡008、M﹡019和M﹡001基因型最常见,但未见MICA﹡012和MICA﹡006基因型。结论移植术前分析供受者的MICA基因多态性,受者的特异性抗体鉴定和特征性分组;移植术后动态监测抗MICA抗体的变化,是肾移植术后预防急性和慢性移植物排斥的重要靶分子。
Objective To investigate the significance of MICA gene polymorphism and anti-MICA specific antibody in renal transplant rejection. Methods Immunomagnetic beads were used to detect the specificity and the positive rate of anti-MICA antibodies in 40 renal transplant recipients before transplantation and at 1 month, 3 months, 6 months, 1 year and 2 years after transplantation Score, and analyzed the MICA genotyping of 16 pairs of renal transplant recipients by SSOP method. The characteristics of MICA gene with the same antigen epitope were divided into G1 group and G2 group. Results In 40 cases of renal transplantation in 35 cases of cadaveric donor, relatives living donor kidneys in 5 cases. All 35 renal transplant recipients survived well with the kidney, of which 33 received dynamic follow-up. There were 12 anti-MICA antibodies pretreated before transplantation, including 10 anti-MICA antibodies and 2 anti-HLA class I + MICA antibodies. 4 were divided into MICA-G1 group and 6 were divided into MICA-G2 group For the MICA-G1 and G2 groups. The frequencies of MICA alleles in donor and recipient groups were the highest: M * 002 and M * 007 in MICA-G1 group, M * 008 and M * 009 and M * 019 in MICA-G2 group . There were 4 newborn anti-MICA antibodies and 3 newborn anti-HLA antibodies after 33 cases transplantation, all of which were anti-donor-specific antibody and non-donor-specific antibody. Pre-stored anti-MICA antibody before transplantation, its specificity did not change in the dynamic follow-up 1 to 2 years after transplantation, while the antibody positive scores showed changes in height. Three cases of anti-MICA antibodies and one antibody negative in 12 cases before transplantation were acute rejection after transplantation. The clinical manifestations were fever, decreased urine volume, and increased resistance index of creatinine and renal artery. The data of 33 cases of dynamic follow-up showed that the genotypes of M * 002, M * 004, M * 008, M * 019 and M * 001 were the most frequent in both MICA genotypes and rejection of MICA-specific antibody Common, but no MICA * 012 and MICA * 006 genotypes. CONCLUSIONS: MICA gene polymorphism, specific antibody identification and characteristic grouping of recipients are analyzed before transplantation. The dynamic changes of anti-MICA antibodies after transplantation are the prevention of acute and chronic graft rejection after renal transplantation Of important target molecules.