肾移植术后PRA与移植肾功能长期预后关系的研究
Study on the relationship between panel reactive antibody and long-term prognosis of transplant renal function
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摘要:目的 研究肾移植术后患者群体反应性抗体(PRA)对移植肾功能长期预后的影响。方法 研究对象为首都医科大学附属北京友谊医院1994年1月至2004年12月进行肾移植手术且在术后2周左右行PRA检测并获得随访患者224例。根据肾移植术后2周左右的PRA检测结果分为阴性组(195例)和阳性组(29例)。阴性组患者于2007年再次检测PRA, 两组患者于近期(2013年10月至2014年4月)检测血清肌酐(Scr), 了解肾功能情况。比较PRA阳性患者(含PRA复查阳性者)和PRA阴性患者的移植肾功能长期正常率。结果 阳性组患者29例, 2014年4月复查18例患者肾功能丧失(17例)或下降(1例), 11例患者肾功能正常。阴性组患者195例, 于2007年复查PRA阴性者153例, 2014年4月复查肾功能正常患者148例, 肾功能下降或丧失者5例;于2007年复查PRA阳性者42例, 移植肾功能均不同程度下降或丧失。2004年前PRA阳性和2007年复查PRA阳性患者共71例, 2014年4月复查肾功能正常患者11例, 移植肾功能长期正常率为15.5%。PRA阴性患者153例, 2014年4月复查肾功能正常患者148例, 移植肾功能长期正常率为96.7%。PRA阳性患者和PRA阴性患者的移植肾长期存活率比较, 差异有统计学意义(P<0.005)。结论 肾移植术后产生PRA对移植肾长期预后有明显影响。Abstract:Objective To study the impact of panel reactive antibody (PRA) on the long-term prognosis of transplant renal function after renal transplantation.Methods The objects of this study were 224 patients, who underwent renal transplantation, received PRA test about 2 weeks after operation and followed up in Affiliated Beijing Friendship Hospital of Capital Medical University from January 1994 to December 2004. According to the PRA test results, the patients were divided into two groups: negative group (n=195) and positive group(n=29). PRA of patients in negative group were tested again in 2007. Serum creatinine (Scr) of patients in both groups were tested recently (from October 2013 to April 2014) to know about the renal function. The rates of long-term normal transplant renal function between PRA positive patients (including PRA re-test positive patients) and PRA negative patients were compared.Results In 29 cases of positive group, the re-test result in April 2014 showed that 18 cases were observed with loss(n=17) or decline(n=1) of renal function, and 11 cases were observed with normal renal function. In 195 cases of negative group, a total of 153 cases were re-tested with PRA negative in 2007, 148 cases were re-tested with normal renal function in April 2014, and 5 cases were observed with decline or loss of renal function. A total of 42 cases were re-tested with PRA positive in 2007 and the transplant renal function was observed decline or loss by varying degrees. There were a total of 71 cases with PRA positive before 2004 and when re-tested in 2007, and 11 cases were re-tested with normal renal function in April 2014. The rate of long-term normal transplant renal function was 15.5%. There were 153 cases with PRA negative and 148 cases were re-tested with normal renal function in April 2014. The rate of long-term normal transplant renal function was 96.7%. Significant difference was observed in the rates of long-term normal transplant renal function between PRA positive patients and PRA negative patients (P<0.005).Conclusions PRA after renal transplantation has obvious impacts on the long-term prognosis of transplant renal function.
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