【摘要】 目的　探讨眼外伤后角膜盲患者在角膜移植术前进行人类白细胞抗原 (HL A)氨基酸残基配型的临床意义。　方法　 6 6例 (6 7眼 )眼外伤后角膜盲患者 ,按角膜新生血管程度分 2组 :新生血管组 5 1眼 ,术前视力眼前手动～指数 ;角膜白斑组 1 6眼 ,术前视力眼前指数～ 0 .1。HL A- 、 类抗原分别由一步单抗法和 DNA法检测。根据 HL A氨基酸残基的相配数分为 HL A低错配组 (2错配、3错配 )和高错配组 (4错配、5错配 )。角膜移植术式 :单纯穿透性角膜移植术、(深 )板层角膜移植术或联合羊膜移植、角膜缘上皮移植手术、带板层巩膜瓣的全角膜移植术。　结果　新生血管组排斥反应率明显高于角膜白斑组 (P<0 .0 5 )。新生血管组中 HL A高错配组排斥反应率高于低错配组 (P<0 .0 1 ) ,相对危险度 RR=1 .772 ,高错配组发生排斥反应的危险性是低错配组的 1 .772倍 ;而且低错配组的术后视力高于高错配组 (P<0 .0 1 )。角膜白斑组中 HL A高错配组排斥反应率高于低错配组 (P>0 .0 5 ) ;术后视力两组差异无显著性 (P>0 .0 5 )。　结论　眼外伤后角膜新生血管丰富者 ,排斥发生率高 ,其中 HL A高错配组的排斥反应率明显高于低错配组 ,术前进行 HL A配型有临床指导意义 ;单纯角膜白斑组术前 HL A配型无特别意义更多还原

【Abstract】 Objective To evaluate the importance of human leucocyte antigen(HLA) amino acid residues cross-matching before keratoplasty in corneal trauma. Methods Sixty-sevsn recipient eyes divided into high-risk(51 eyes) and low-risk(19 eyes) groups according to the degree of neovasvularization in cornea. HLA-Ⅰ, HLA-Ⅱ were typed by means of monoclonial antibody and by DNA-based method respectively before keratoplasty. The cases were subdivided into 2 groups: high mismatching group composed of 4 mm, 5 mm(mismatching locus) and low mismatching group composed of 2 mm, 3 mm. {Results} The rejection rate in high-risk group(76 5%) was significantly higher than low-risk group(31 3%), P<0 05. And in high-risk group, the rejection rate(90 5%) in high-mismatching group was much higher by 1 772 times than low-mismatching group(63 2%), P<0 05, RR=1 772(Fisher test). The best-corrected visibility in low-mismatching group was better than high-mismatching group(Radit test P<0 01). However, in low|risk group there was no significant difference between high mismatching(33 3%) and low mismatching(25 0%),P>0 05(Fisher test). The best-corrected visibility has no significant difference in low-mismatching group. Conclusion The results showed that HLA amino acid residues cross-matching played an important role in reducing rejection rate, which demonstrated the fact of requiring accurate HLA typing before keratoplasty. If possible, we should choose the better matched donor-recipient according to the HLA amino acid residues cross-matching especially in the recipient eyes with much neovascularization.;更多还原