Luminex技术监测抗HLA抗体对肾移植受者预后的影响

摘要

Objective To investigate the value of anti-human leukocyte antigen (HLA)antibody level detected by Luminex testing in predicting clinical prognosis of renal transplantation recipients. Methods A total of 1 105 patients scheduled to undergo renal transplantation (354 successfully undergoing renal transplantation)in the 181st Hospital of People's Liberation Army from June 2013 to November 2015 were selected. The serum samples were collected from 1 923 cases before and after renal transplantation. The positive rate and fluorescent intensity of anti-HLA antibody were detected by Luminex testing before and after renal transplantation. The renal function of recipients was also evaluated after renal transplantation. Results Prior to renal transplantation,51.0%(546/1 071)of serum samples were positive for anti-HLA antibody,including 26.0%(279/1 071)positive for anti-HLAⅠantibody,24.9%(267/1 071)positive for anti-HLAⅡantibody and 11.4% (122/1 071 )positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies. Among 354 patients undergoing renal transplantation,59 (17%)were positive for anti-HLA antibody after renal transplantation,including 25 (4 newly positive after surgery)positive for anti-HLAⅠantibody,15 (1 newly positive after surgery)positive for anti-HLAⅡantibody and 19 (4 newly positive after surgery)positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies. During subsequent follow-up,13 patients positive for anti-HLAⅠantibody,5 positive for anti-HLAⅡantibody and 1 1 positive for both anti-HLA Ⅰ and anti-HLA Ⅱ antibodies developed transplant kidney dysfunction. All patients newly positive for anti-HLA antibody after renal transplantation presented with transplant kidney dysfunction. Conclusions Luminex testing can perform dynamic detection of the positive rate of anti-HLA antibody,which is important in predicting clinical prognosis of recipients after renal transplantation.%目的：探讨Luminex技术检测受者体内抗人类白细胞抗原（HLA）抗体水平在预测肾移植受者预后的价值。方法选取2013年6月至2015年11月在解放军第181医院拟行肾移植患者1105例（其中354例成功接受肾移植手术），收集肾移植术前、术后血清标本共1923例次。采用Luminex技术检测术前和术后的抗HLA抗体的阳性率和抗体荧光强度，同时并对移植受者进行移植肾功能检测。结果术前抗HLA抗体阳性血清样本占总数的51.0％（546／1071），其中抗HLAⅠ类抗体阳性占26.0％（279／1071），抗HLAⅡ类抗体阳性占24.9％（267／1071），其中抗HLA抗体Ⅰ、Ⅱ类均为阳性占11.4％（122／1071）。354例肾移植患者中，术后出现抗HLA抗体者占17％（59／354），其中单独抗HLAⅠ类抗体阳性者25例（术后新发阳性4例），单独抗HLAⅡ类抗体阳性者占15例（术后新发阳性1例），两者皆阳性者19例（术后新发阳性4例）。随访期间，术后抗HLAⅠ类、Ⅱ类及两种抗体均阳性者出现移植肾功能异常者分别为13例、5例和11例，其中术后抗体新发阳性者均出现移植肾功能异常。结论 Luminex技术可动态监测肾移植术后受者抗HLA 抗体水平，而抗HLA抗体阳性对预测肾移植受者预后有重要的价值。