【摘要】 目的:预致敏的人白细胞抗原特异性抗体(HLA)是抗体介导排斥反应的主要危险因素。本研究对肾移植受者术前进行HLA特异性抗体检测和分析,以评价其致敏状态。方法:1998年至2007年于我院等待肾移植的受者共3500名。2000年3月前694名受者采用补体依赖微量细胞毒性试验(CDC)进行群体反应性抗体(PRA)检测,之后2806名受者改为用酶联免疫吸附实验(ELISA)检测。对致敏受者HLA抗体多样性和特异性,以及致敏相关因素进行分析。结果:CDC方法仅能检出抗HLAⅠ类IgG抗体,而ELISA可检出抗HLAⅠ类和Ⅱ类抗体。CDC方法所检出的病人血清PRA阳性率比ELISA方法检出的阳性率低。而且,ELISA能分别检出抗HLA-A、B、CW、DR和DQ抗原的抗体20种、37种、8种、14种和7种。抗HLA-A2、24、68、23、32;B27、56、57、7;DR7、4、9、13、17、12;CW1、2、6、4、8等位基因产物的抗体频率较高。这些抗HLA抗体与华南地区人群HLA抗原分布不尽一致。不同性别PRA阳性率存在显著性差异,男性以输血致敏为主,女性以输血、妊娠致敏为主。结论:采用ELISA方法能较为准确地检出抗HLA特异性抗体。避免供受者间常见高频抗体相应的HLA位点的错配和减少输血是减少抗HLA抗体的产生,以提高移植物存活的有效手段。更多还原

【Abstract】 Objective:Preformed anti-human leukocyte antigen(HLA)specific antibodies are a major risk for antibody-mediated rejection.The aim of this study is to detect and analyze anti-HLA specific antibodies in sera of renal transplant candidates for evaluating the status of presensitization.Methods:A total of 3 500 patients awaiting renal transplantation in our hospital from 1998 to 2007 were included in the study.Panel reactive antibody(PRA)in sera of 694 candidates was detected by complement-dependent cytotoxicity(CDC)before March 2000,then the sera of other 2 806 recipients were screened by enzyme-linked immune absorbent assay(ELISA)alternatively.The polymorphism,specificity and relevant factors of anti-HLA antibodies were analyzed.Results:Only IgG type of antibodies specific to HLA classⅠcould be detected by CDC,whereas both anti-HLA classⅠand classⅡ of IgG class could be found out by ELISA.Lower PRA positive rate by CDC(8%)was shown when compared to that by ELISA(17%).Furthermore,multiple types of specific antibodies against HLA-A(20),B(37),CW(8),DR(14)and DQ(7)were determined by ELISA.Some types of the antibodies presented higher frequencies,such as anti-HLA-A2,24,68,23 and 32;B27,56,57 and 7;DR7,4,9,13,17 and 12;CW1,2,6,4 and 8.These high frequenies of anti-HLA antibodies were somewhat different from the distribution of HLA antigens in South China population.There were significantly different positive rates of anti-HLA antibodies between the male and the female,as the male were sensitized mainly through blood infusion and the female were sensitized by either blood infusion or pregnancy.Conclusion:Specific antibodies against HLA can be detected out by ELISA accurately,whereby to find high freguencies of the antibodies and to avoid donor-recipient mismatching at HLA-loci.Detection of preformed anti-HLA and reducion of HLA-mismatched blood infusion to reduce production of anti-HLA antibodies may be the valuable pathway to improve graft survival.更多还原