终末期肾脏疾病患者MICA与HLA致敏的相关性

目的探讨终末期肾脏疾病(ESRD)患者中主要组织相容性复合体Ⅰ类相关链A(MICA)抗原与人类白细胞抗原(HLA)致敏的相关性。方法根据HLA致敏情况将60例ERSD患者分为HLA致敏组(n=30)和非HLA致敏组(n=30)并采集临床资料,采用ELISA方法进行HLA致敏情况分析、Luminex100免疫磁珠流式细胞仪进行MICA致敏情况分析。结果HLA致敏患者都存在输血、妊娠和(或)移植史,HLA致敏组有输血史和移植史的患者百分率均高于非HLA致敏组(均P<0.05);两组中MICA致敏的患者共17例,其中16例有输血、妊娠和(或)移植史,1例既往无输血和移植史、无HLA致敏的32岁男性患者存在MICA致敏。HLA致敏组中MICA致敏率高于非HLA致敏组(40.0%vs16.7%,2=4.02,P<0.05)。结论HLA致敏与输血、移植、妊娠相关,而MICA致敏的途径尚未完全清楚,除输血、妊娠和移植等致敏途径外,可能存在天然的抗-MICA抗体。MICA致敏与HLA致敏之间存在相关性,这种伴随关系可能与输血、妊娠或移植等途径共同致敏有关。对非HLA致敏占大多数的ERSD患者进行MICA致敏状态的监测,将有助提高ERSD患者肾移植的长期生存率和远期移植效果,进一步增加肾移植的安全性。

Association between sensitization against MICA and HLA in ESRD patients

Objective To investigate the association of sensitization against MICA (Major histocompatibility complex class I-related chain A) and HLA (human leucocyte antigen) in end-stage renal disease (ESRD) patients.Methods According to the status of HLA sensitized,60 patients were divided into HLA sensitized group(n=30) and HLA nonsensitized group(n=30). Clinical data was collected. ELISA was used to identify HLA antibody. Luminex flow cytometry was used to identify MICA antibody and antibody specificity in both groups.Results Each HLA sensitized patient had the history of transfusion, pregnancy and/or transplantation. Compared to HLA nonsensitized group, HLA sensitized group had a significantly higher percentage of transfusion and transplantation (P<0.05,respectively). Sixteen patients sensitized against MICA had the history of transfusion, pregnancy and/or transplantation in total 17 MICA sensitization patients, but no such a history was found in a 32 year old male with MICA sensitization and without HLA sensitization. Compared to HLA nonsensitized group, MICA sensitized rate was significant higher in HLA sensitized group(40%:16.67%,x2= 4.02,P<0.05). Conclusions HLA antibody positive patients have the history of HLA sensitization, but mechanism of MICA sensitization remained unclear. In addition to transfusion, pregnancy or transplantation, nature MICA antibody can occur. There is association between sensitization against MICA and HLA, which is associated with common sensitization via transfusion, pregnancy or transplantation. Monitoring the sensitized status of MICA, especially for the HLA nonsensitized of ESRD patients in majority, would enhance survival and effect in long-term renal transplantation.