摘要
背景:国内外有关预防高致敏受者肾移植后发生超急性、急性排斥反应提高人肾存活率取得满意效果,然而临床对群体反应性抗体检测阴性既往致敏受者肾移植后发生再次免疫应答研究则罕见报道。目的:探讨群体反应性抗体阴性的既往致敏受者肾移植后早期发生严重急性体液性排斥反应机制,为其早期诊断和治疗既提供参考依据。方法:选择21例群体反应性抗体阴性术后早期发生严重急性体液性排斥的首次肾移植患者,动态分析移植后14d内反映急性体液性排斥的相关指标,包括IgG型抗HLA抗体,病理苏木精-伊红染色、C4d及细胞表面分子原位检测。结果与结论:21例患者既往均有输血或妊娠史;18例患者移植后第7天抗HLAⅠ类IgG抗体阳性率>80%,11例于移植后第7天抗HLAⅡ类IgG抗体>80%;5例女性患者于移植后第5～8天发生移植肾破裂,抗HLAⅠ类和Ⅱ类IgG抗体均>96%;21例受者均检出抗供者特异性抗体(DSA),13例(61.90%)供、受者存在HLA-A2和HLA-A11的错配并产生对应DSA,包括5例移植肾破裂受者;病理组织形态学均有不同程度急性损伤,免疫组化可见管周毛细血管区(PTC)C4d沉积,原位染色CD34(+)、CD68(+)、CD4(+)。提示移植前群体反应性抗体监测不能完全反映受者的预致敏状态;移植后早期监测群体反应性抗体可预测和诊断既往致敏受者急性体液性排斥的发生;C4d、CD68(+)作为其的辅助诊断指标,可提高诊出率;HLA-A2和HLA-A11在既往致敏受者是高危致敏基因。
BACKGROUND：The prevention of hyperacute or acute rejection in highly sensitized recipients after renal transplantation has obtained satisfactory results. However, there are rare reports about secondary immune response of sensitized recipients with negative panel reactive antibody （PRA） after kidney transplantation. OBJECTIVE：To explore the mechanism of acute humoral rejection （AHR） in sensitized recipients with negative PRA for early prophylaxis. METHODS：The AHR related factors including HLA IgG HE stain, anti-C4d deposition and cell surface molecules were analyzed in 21 PRA negative recipients receiving kidney for the first time from the 1st day to the 14th day post-Tx. RESULTS AND CONCLUSION：All the 21 patients had records of blood transfusion or pregnancy. In 18 patients, anti-HLAⅠIgG and 11 pones anti-HLAⅡIgG positive rates were both over 80% on the 7th day. Five female ones were found rupture of allograft and both anti-HLAⅠand anti-HLAⅡIgG positive rates were over 96% during the 5th and 8th day. DSA（donor specific antibodies） were found in all the 21 patients, among of them, 13 patients including 5 ones with rupture of kidney had mismatching of HLA-A2 and HLA-A11. Kidney damage was shown by patho-histomorphology examination. Immunohistochemistry examination showed C4d deposition in peritubular capillary zone （PTC）, In situ staining showed CD34（＋）,CD68（＋）and CD4（＋） positive. Pre-operative test of PRA can reflect the sensitization to some extent but not completely. Prediction and diagnosis of AHR would be done by early monitoring of PRA post-Tx. The diagnosis rate of AHR could be improved by the specific pathological markers of C4d and CD68 which were used as diagnostic criteria. HLA-A2 and HLA-A11 are genes highly dangerous for sensitized patients suffering from AHR.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2011年第18期3315-3318,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
广东省自然科学基金(06024438)
课题名称:肾移植术后慢性排斥体液免疫发病机制研究~~
作者简介
陈剑荣,女,1969 年生,广东省茂名市人,汉族,2004 年解放军第一军医大学毕业,硕士,副主任技师,主要从事临床移植免疫方面的研究.liliuyang@medmail.com.cn｜
通讯作者：赵明,博士,教授,博士生导师.南方医科大学附属珠江医院器官移植科,广东省广州市510282zhaoming02@hotmail.com
