【摘要】 目的:探讨肾移植后产生HLA抗体的影响因素,以及这些抗体对移植肾肾功能的影响。方法:采用Luminex技术检测92例肾移植后患者外周血HLA抗体,并随访1年时间,研究抗体和移植肾预后的关系。结果:HLA抗体的阳性率为58.7%,HLA-I类抗体在女性更易产生,而HLA-II类抗体的产生和性别无关,但和移植后时间有关,移植后时间越长,HLA抗体阳性率越高;并且发现,移植前诱导治疗采用多克隆抗体者HLA抗体产生的机会较小。在移植肾预后方面,HLA-II类抗体和移植肾晚期失功相关,而单独HLA-I类抗体的出现和移植肾晚期失功关系不大,HLA-I类和HLA-II类抗体同时存在对移植肾有协同破坏作用,移植肾生存率最低。多因素分析表明,HLA-I类和II类抗体同时出现移植肾失功的风险为阴性者的7.9倍(OR=7.9,95%CI:3.2～30.1),而HLA-II类抗体阳性者移植肾失功的风险为阴性者的5.1倍(OR=5.1,95%CI:1.1～24.2)。结论:肾移植术后HLA抗体和移植肾预后密切相关,而HLA-II类抗体和移植肾晚期失功相关。更多还原

【Abstract】 Objective:To conduct a systematic study of antibodies against HLA in patients who had received a renal transplant within the past 10 years and to evaluate the effect of these antibodies on graft survival. Methods: We prospectively examined the sera of 92 patients who had undergone a first-kidney transplantation performed in the past 10 years. All patients were followed one year. Testing for anti-HLA antibodies was performed by Luminex methods. Results: Among the 92 patients, 58.7% had anti-HLA antibodies, Female gender was associated with the presence of anti-HLA class I antibodies and the overall frequencies of anti- HLA class II antibodies was found to increase with time. Patients who used ATG as induction therapy had less frequencies of anti- HLA antibodies. Graft function deterioration was associated with anti-HLA class II antibodies, but not with the presence of only anti-HLA class I antibodies. Cox regression model showed anti-HLA class I and II antibodies had the strongest effect with hazard ratio (HR) of 7.9, and anti-HLA class II antibodies had a HR of 5.7. Conclusion: the presence of anti-HLA class II antibodies conferred a risk for graft loss before a decline in renal function and increased the risk of graft failure.更多还原