肾移植受者术前血清抗血管内皮细胞抗体与急性排斥反应的关系

目的 研究肾移植受者术前血清抗内皮细胞抗体（AECA）的水平对术后6个月内发生急性排斥（AR）的预测作用。 方法 将1998年12月至2003年8月在本中心行同种异体肾移植并存有血标本的495例受者纳入研究。回顾总结术后6个月内AR发生情况及相关资料。健康对照（阴性对照）40例。采用细胞-ELISA法，以EA.hy926细胞（人脐静脉内皮细胞株）为底物检测血清AECA水平。结果采用比值表示，P（患者）/N（阴性对照）=（A患者标本-A空白对照）/（A阴性对照-A空白对照）。P/N大于健康对照组均值加2个标准差者为阳性。 结果 495例患者血清中，AECA阳性93例（18.8%）。维持血透时间大于12个月患者血清AECA水平（1.43±0.37）显著高于未透析患者（1.27±0.32，P = 0.013）及维持血透时间≤12个月患者（1.31±0.32，P = 0.029）。血清AECA水平与透析时间呈正相关（r = 0.218，P = 0.018）。AECA阴性、阳性患者术后6个月内AR发生率分别为23.4%、38.7%，差异有统计学意义（P = 0.002）。AECA阳性患者细胞性AR、体液性AR的发生率均显著升高（P = 0.035，P = 0.002）。多元Logistic回归分析显示AECA阳性、群体反应性抗体（PRA）≥10%、高淋巴毒反应为发生AR的独立危险因素，优势比（OR）分别为2.056、1.751、1.764（P值分别为0.004、0.029、0.050）。 结论 肾移植受者术前血清AECA阳性预示术后发生急性排斥反应的风险增加。术前血清AECA水平随透析时间延长而升高。

Association of pre-transplant serum level of anti-endothelial cell antibody with acute rejection in kidney transplant recipients

Objective To study the pre-transplant serum level of anti-endothelial cell antibody(AECA)in kidney allograft recipients and its impact on the episode of acute rejection (AR) within 6 months after transplantation. Methods A total of 495 kidney allograft recipients with pre-transplant serum between December 1998 and August 2003 in our center and 40 healthy controls(negative controls)were enrolled in the study.Clinical data including AR within 6 months after transplantation were analyzed retrospectively.The serum AECA level was measured by cyto-ELISA using EA.hy926 cells as substrate,which was shown as the ratio of P (patient)/N (negative control)=(A_(petient)-A_(blank contrnal)/(A_(negative contral)-A_(blank contral).AECA was considered positive when P/N value Was greater than the average A_(negative control)value plus two times the standard deviation.Results Positive rate of AECA was 18.8%(93/495).AECA level in hemodialysis patients who had been on hemodialysis more than 12 months was 1.43±0.37,greater than those less than 12 months(1.27± 0.32,P=0.013)and those of non-dialyzed patients(1.31±0.32,P=0.029).Correlation coeffieient between AECA level and hemodialysis duration was 0.218 (P=0.018).AR incidence in AECA positive recipients was 38.7%,greater than that in AECA negative recipients (23.4%,P=0.002). Incidence of acute T cell-mediated rejection and acute antibody-mediated rejction increased significantly (P=0.035,P=0.002 respectively).Multifactor logistic regression analysis indicated that AECA positive,PRA greater than 1 0%and high CDC level were risk factors of AR with odds ratio of 2.056,1.751 and 1.764 respectively(P=0.004,0.029,0.050). Conclusions The AECA positive in pre-transplant serum indicates the elevated risk of acute allograft rejection.The AECA level increases with prolonged hemodialysis duration.