高群体反应性抗体患者致敏因素分析

目的:对群体反应性抗体(PRA)增高的原因进行分析。方法:316例肾移植患者接受PRA检测。首先采用LATM检查,阳性患者再采用LAT方法进行检测,对高PRA患者的成因采用多因素分析。同时尝试用检测IgG1的方法替代检测IgG的方法来改良传统PRA的检测。结果:高PRA患者共有78例,PRA水平自10%~90%不等。男、女致敏率分别为18%和38.1%,差异有统计学意义(P<0.05);透析时间1年以上和1年以下的致敏率分别为22.7%和21.8%,两者差异无统计学意义(P>0.05);输血者和无输血者致敏率分别为43%和21%,两者差异有统计学意义(P<0.05);妊娠者和无妊娠者的致敏率分别为37.6%和7.8%,有移植史者和无移植史者的致敏率分别为78.7%和20.3%,两者差异均有统计学意义(P<0.01)。同时有移植史和输血史患者的致敏率高达91.4%,并有输血和妊娠的女性患者致敏率为74%。PRA的抗体频率分布与HLA抗原频率分布并不一致。HLA抗原出现频率较高的有A2、A11、A24、、B60、B51、DR15、DR4等,而PRA的抗体出现频率较高的为A24、A19、A2、B13、B46、B40、DR9等。结论:移植史、输血史、妊娠史及性别是致敏因素,这些致敏因素有协同作用,可提高致敏率。某些HLA抗原更易使机体产生抗体。

Analysis of contributing factors in renal transplant recipients with high pannel reactive anti HLA antibodies(PRA)

Objective:To analyse the contributing factors of subjects with high PRA.Methods:Totally 316 renal transplant recipients were included in this study.LATM detection was used for screening positive subjects and LAT was performed further.The relationship between the levels of anti-HLA antibodies and sex,time of dialysis,transfusion,pregnancy,former transplantation were analysed.Results:High PRA level was noted in 78 of 316 patients,with the PRA level from 10% to 90%.The sensitive rates were 18% in males and(38.1)% in females,43% in transfusion recipients and 21% in nontransfusion recipients,(37.7)% in pregnancy group and(7.8)% in nonpregnancy group,(78.7)% in pretransplant group and(20.3)% in nontransplant group respectively.The sensitive rates were(91.4)% in patients with history of transplant and transfusion,74% in patients with history of transfusion and pregnancy respectively.The distribution of PRA antigens were not consistent with HLA antigens and the higher frequency of occurrence of PRA antigens are anti-A2,A11,A24,B60,B51,DR15,DR4.Conclusions:Single factor analysis showed that the sex,former transplantation,transfusion and pregnancy were the risk factors of sensitization and these factors could cooperate with each other and make the PRA level higher.Some HLA antigens are prone to be sensitized.