肾移植患者围手术期群体反应性抗体检测的临床意义

目的:研究肾移植患者围手术期群体反应性抗体(PRA)的水平与移植肾急性排斥的关系。方法:采用ELISA-PRA检测法,对34例尸体肾移植患者进行手术前、术后1周、术后2周、术后1个月血清PRA检测,并分析其结果与肾移植急性排斥的关系。结果:34例患者中,移植前PRA阳性者(PRA)>10％)9例(26.5％),有5例PRA>50％(51％～80％),术前行血浆置换。PRA阴性者25例(73.5％)。PRA阳性组中,有5例发生急性排异,其中2例切除移植肾恢复血液透析。PRA阴性组中,有4例发生急性排异,治疗后肾功能恢复正常。两组相比排异发生率有统计学差异(P<0.05)。术后PRA阳性者11例(术前PRA阴性转阳者2例),发生排异6例(1例为术前PRA阴性)。术后PRA阴性者中,有3例发生排异。两组相比排异发生率有统计学差异(P<0.05)。结论:①患者肾移植术前体内PRA水平对移植肾排异有显著影响;②患者肾移植术后体内PRA水平影响移植肾急性排异的发生和转归。

Detection of Panel Reactive Antibody in Kidney Recipients in Perioperative Period: the Clinical Relevance

Objective: To study the relationship between the level of panel reactive antibody (PRA) in kidney recipients in perioperative period and the acute rejection of the graft. Methods : Thirty-four cases of kidney recipients were enrolled.The level of PRA preoperation, 1,2 and 4 weeks after operation was detected by ELISA-PRA method. Results: Before transplantation, PRA was positive in 9 cases(26.5%), negative in 25 cases(73.5%). The level of PRA in 5/9 cases was more than 50%. The therapy of plasmapheresis was accomplished in those 5 cases before operation. In the group of positive PRA,there was acute rejection in 5 patients, and grafts were removed in 2 patients. In the group of negative PRA, there was acute rejection in 4 patients. After conventional treatment, renal function was reversible into normal. There was significant difference in acute rejection between the groups of positive and negative (P<0.05). After transplantation, 11 cases had positive PRA, two of whom were negative of PRA before transplantation. Conclusion: (1)The level of PRA was very important evidence predicting acute rejection before operation; (2)The elevation of PRA after transplantation was correlated with acute rejection and its outcome.