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肾移植术后抗体监测和移植肾病理学检查有助于早期诊断抗体介导的排斥反应

傅茜 王长希 李军 何润钧 刘龙山 邓素雄 费继光 邱江 陈国栋 黄刚 陈立中

傅茜, 王长希, 李军, 等. 肾移植术后抗体监测和移植肾病理学检查有助于早期诊断抗体介导的排斥反应[J]. 器官移植, 2016, 7(6): 433-437. doi: 10.3969/j.issn.1674-7445.2016.06.004
引用本文: 傅茜, 王长希, 李军, 等. 肾移植术后抗体监测和移植肾病理学检查有助于早期诊断抗体介导的排斥反应[J]. 器官移植, 2016, 7(6): 433-437. doi: 10.3969/j.issn.1674-7445.2016.06.004
Fu Qian, Wang Changxi, Li Jun, et al. ntibody monitoring and graft biopsy after renal transplantation contribute to early diagnosis of antibody mediated rejection[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 433-437. doi: 10.3969/j.issn.1674-7445.2016.06.004
Citation: Fu Qian, Wang Changxi, Li Jun, et al. ntibody monitoring and graft biopsy after renal transplantation contribute to early diagnosis of antibody mediated rejection[J]. ORGAN TRANSPLANTATION, 2016, 7(6): 433-437. doi: 10.3969/j.issn.1674-7445.2016.06.004

肾移植术后抗体监测和移植肾病理学检查有助于早期诊断抗体介导的排斥反应

doi: 10.3969/j.issn.1674-7445.2016.06.004
基金项目: 

国家自然科学基金 81270836

广东省自然科学基金(博士启动项目) S2013040012588

广东省科技计划项目 2014A020212708

广东省科技计划项目 2014B0202120060

广东省重点实验室基金项目 2013A061401007

广州市科技计划项目 2014Y2-00114

详细信息
    通讯作者:

    王长希. E-mail:wcx6363@163.com.

  • 中图分类号: R617,R365

ntibody monitoring and graft biopsy after renal transplantation contribute to early diagnosis of antibody mediated rejection

More Information
  • 摘要:   目的   分析肾移植术后抗人类白细胞抗原(HLA)抗体监测和移植肾穿刺病理学检查早期诊断抗体介导的排斥反应(AMR)的必要性。   方法   筛选51例术后产生新生供体特异性抗体(dnDSA)的受者,检测供体特异性抗体(DSA)及其结合C1q的能力,同时进行移植肾穿刺病理诊断。对于符合AMR诊断的受者,比较分析移植肾功能不稳定组和稳定组受者的DSA类别、补体结合能力和移植肾病理组织Banff评分。对无排斥反应组、移植肾功能不稳定组和稳定组受者的移植物进行Kalan-Meier生存分析。   结果   在移植肾功能不稳定组和稳定组受者中,HLA抗体的不同类别、DSA的平均荧光强度(MFI)值、补体相关检测C1q结合力和C4d管周毛细血管沉积情况差异均无统计学意义(均为P>0.05)。在组织形态学损伤方面,两组在微血管炎、动脉内膜炎、肾小管-间质炎、移植肾小球病、肾小管萎缩-间质纤维化等表现的Banff评分差异均无统计学意义(均为P>0.05)。移植肾功能不稳定组受者移植物累积存活率显著低于稳定组,稳定组明显低于不符合排斥病理诊断的受者(P=0.002)。   结论   肾移植术后定期监测抗HLA抗体和做移植肾病理穿刺检查非常必要,有助于早期发现和诊断AMR。

     

  • 图  1  3组受者移植肾的Kaplan Meier生存曲线

    Figure  1.  Kaplan Meier survival curves for kidney graft of recipients in 3 groups

    表  1  AMR受者移植肾功能不稳定组与稳定组的临床和病理特点

    Table  1.   Clinical and pathological features of AMR recipients with stable and unstable function

    指 标移植肾功能不稳定组(n=15)移植肾功能稳定组(n=30)P
    年龄(岁)41±1335±130.202
    性别(男/女,n/n)8/722/80.077
    供者类型(亲属活体/尸体,n/n)4/118/220.458
    移植后时间[年,M(Q1/4~3/4)]7.0(1.0,12.7)4.5(1.6,7.0)0.656
    DSA Ⅰ类(n)670.56
    DSA Ⅱ类(n)14300.33
    C1q-DSA(n)9180.629
    dnDSA MFI(x±s)12 545±5 25511 021±4 8300.338
    肾穿检查时Scr(μmol/L,x±s)363±134143±390.000
    肾穿检查时24 h尿蛋白[g,M(Q1/4~3/4)]2.0(0.5,5.1)0.5(0.2,1.0)0.014
    Banff评分[M(Q1/4~3/4)]
    小球炎+管周毛细血管炎3(3,3) 3(2.5,3.5)0.958
    C4d管周毛细血管沉积2.0(1.0,3.0)2.0(0.5,3.0)0.664
    移植肾小球病1.0(0,3.0) 0(0,1.0)0.436
    肾小管-间质炎2.0(1.0,2.0)1.0(0,3.0) 0.140
    动脉内膜炎0(0,1.0)0(0,0) 0.617
    肾小管萎缩-间质纤维化1.0(1.0,2.0)1.0(1.0,1.5)0.292
    注:DSA为供体特异性抗体;dnDSA为新生供体特异性抗体;MFI为平均荧光强度;Scr为血清肌酐
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出版历程
  • 收稿日期:  2016-07-31
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2016-11-15

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