抗MICA抗体的致敏因素分析及其对肾移植的影响

摘要

Objective To investigate the risk factors for sensitization of anti-MICA antibodies and their impact on the outcomes of renal transplantation. Methods Luminex flow cytometry were used to identify 10 MICA antibodies and evaluate the antibody specificity in 98 uremic patients positive or negative for anti-MICA antibodies undergoing kidney transplantation. The factors contributing to MICA sensitization were analyzed, and the incidence of acute rejection and graft function recovery time were compared between the positive and negative cases for anti-MICA antibodies. Results Of the 98 uremic patients, 16 (16.3%) were positive for anti-MICA antibodies. The positive and negative cases showed significant differences in the history of blood transfusion, pregnancy, transplantation, and PRA status (P＜0.05). In the 38 renal transplant recipients, 6 experienced acute graft rejection, which was reversed by methylprednisolone pulse therapy; of the 10 recipients positive for anti-MICA antibodies, 4 showed acute graft rejection as compared to 2 out of the 28 recipients negative for anti-MICA antibodies (P=0.031). The cases positive for anti-MICA antibodies showed a significantly longer graft function recovery time than the negative cases (14.6±4.7 vs 8.2 ±4.5 days, P=0.001). Conclusion Blood transfusion, pregnancy, and transplantation all contribute to the production of anti-MICA antibodies. Patients positive for anti-MICA antibodies may require strict HLA matching and more potent immunosuppressive drugs to prevent renal graft rejection and improve graft survival.%目的 探讨抗MICA抗体的致敏因素及其对肾移植的影响.方法 采用液相芯片分析技术检测98例尿毒症患者血清中10种抗MICA抗体及其抗体特异性,根据抗MICA抗体分为抗MICA抗体(+)组和抗MICA抗体(-)组,分析MICA致敏原因;对其中已行同种异体肾移植手术患者,比较抗MICA抗体(+)组和抗MICA抗体(-)组两组急性排斥反应(AR)发生率,移植肾功能恢复时间等资料.结果 98例尿毒症患者中,16例检测到抗MICA抗体,阳性率为16.3%,抗MICA抗体(+)组和抗MICA抗体(-)组输血、妊娠、移植、PRA等因素有显著性差异(P＜0.05).38例肾移植受者,6例发生AR,经甲基强的松龙冲击治疗后均逆转.其中抗MICA抗体(+)组10例,4例发生AR;抗MICA抗体(-)组28例,2例发生AR.两组间AR发生率有显著性差异(40%vs7%,P=0.031).抗MICA抗体(+)组移植肾功能恢复时间(14.6±4.7 d)高于抗MICA抗体(-)组(8.2±t4.5 d)(P=0.001).结论 输血、妊娠、移植等因素可以引起抗MICA抗体产生.对于抗MICA抗体(+)患者,需要严格的配型和更强有力的免疫抑制药物,来预防排斥反应,提高移植肾存活率.