肾移植受者血清群体反应性抗体水平与术后早期排斥反应间的关系

目的探讨肾移植受者血清群体反应性抗体（PRA）水平与术后早期排斥反应间的关系。方法对256例肾移植受者术前测定其血清PRA水平,并对PRA与术后早期排斥反应（超急性、加速性、急性排斥反应）之间的关系进行分析。结果PRA阴性组、轻度致敏组、高致敏组3组间术后早期排斥反应发生率差异有统计学意义（χ^2=78.23,P〈0.01）,组间两两比较,差异有统计学意义（q=-8.32～-2.87,P〈0.05、0.01）。男性组PRA阳性率低于女性组（χ^2=14.18,P〈0.01）;无输血史组PRA阳性率低于有输血史组（χ^2=5.39,P〈0.05）;有妊娠史组与无妊娠史组PRA阳性率比较差异无显著性（χ^2=0.66,P〉0.05）;二次移植组PRA阳性率明显高于初次移植组（χ^2=20.10,P〈0.01）。结论输血、再次移植是PRA阳性的危险因素。随着PRA水平的升高,术后早期排斥反应的发生率升高。肾移植受者血清低水平的PRA可降低术后早期排斥反应的发生,提高人、肾生存期。

RELATIONSHIP BETWEEN SERUM PANEL REACTIVE ANTIBODY OF RECIPIENTS AND EARLY POSTOPERATIVE REJECTION IN RENAL TRANSPLANTATION

Objective To study the association of the level of serum panel reactive antibody （PRA） in recipients with ear ly rejection after kidney transplantation. Methods The serum level of PRA in 256 recipients were detected preoperatively, its correlation with early-postoperative rejections, i.e. hyper acute, accelerated, and acute rejection, were analyzed. Results The differences of early postoperative rejection rates among PRA negative group, lightly sensitive group and hyper sensitive group were with highly statistical significance （X^2=78.23,P〈0.01）. PRA positive rate in male was lower than in female （X^2=14. 18,P〈 0.01）; that in the group without a history of blood transfusion was lower than that in those with transfusion （X^2= 5. 39, P〈 0.05） ; no difference was noted of PRA between those with a history of gestation or without （X^2= 0.66,P〉0.05）. PRA positive rate in those underwent twice transplantations was bigher than those underwent procedure for the first time （x^2= 20. 10,P〈 0.01 ）. Conclusion Blood transfusion and retransplantation are the risk factors of PRA positive. The rate of early- postoperative rejection increases along with the elevation of PRA level. Recipients with low serum PRA may reduce early rejection and improve the survival of the patient and kidney.