HLA配型和PRA对移植肾功能的影响研究

摘要

目的 研究肾移植患者人白细胞抗原(HLA)配型和群体反应性抗体(PRA)与移植后肾功能的关系.方法 根据肾移植术前HLA配型结果,观察HLA配型和PRA对肾移植受者术后急性排斥反应发生率和移植肾功能的影响.结果 121例尸体肾移植受者肾移植术后发生急性排斥反应的有15例,占12.40%;6例PRA阳性,占4.96%;29例目前肾功能下降或丧失,占23.97%.HLA-A、B、DR、DQ位点4个抗原错配或以下的51例,肾功能良好者44例,占86.27%;大于4个抗原错配的70例,肾功能良好者48例,占68.57%;两者之间有显著性差异.肾移植患者HLA-A、B、DR、DQ错配4个抗原或以下的51例,发生急性排斥2例,占3.92%;HLA-A、B、DR、DQ错配4个抗原以上的70例,发生急性排斥13例,占18.57%,两者之间有显著性差异.结论 良好的HLA配型可降低移植肾的急性排斥反应发生率.PRA抗体阳性可导致移植肾功能下降,但HLA配型不影响PRA抗体的产生.%Objective To investigate the effects of HLA typing and panel reaction antibody(PRA) on graft function of kidney post transplantation. Methods According to the test results of pre-transplant HLA typing, the effect of HLA typing and PRA on the incidence of renal acute rejection CAR) and the graft function in recipients post kidney transplantation. Results In the 121 recipients, 15(12. 40%) cases were with renal AR,6(4. 97%) cases were positive with PRA and 29(23. 97%) cases were with the deterioration or loss of graft function. Among the 51 recipients,with four or less mismatches of antigen HLA-A,B,DR and DQ,and 70 recipients, with more than 4 mismatches,44(86. 27%) and 48(68. 57%) cases, respectively, were with good graft function,and the percentages of the two groups were statistically different. Of the two groups, mentioned above, the incidences of AR were 3. 92% and 18. 57% respectively, and the percentages of the two groups were also statistically different. Conclusion Fine HLA matching could significantly reduce the incidence of AR. Functional deterioration of grafted kidney is associated with the positivity of PRA,but HLA matching might not influence the production of PRA.