2429 例尿毒症患者致敏因素的分析

目的 分析尿毒症患者肾移植前存在的致敏因素. 方法 自2002年4月至2008年12月,共对2429例准备进行肾移植的尿毒症患者进行了群体反应性抗体(PRA)的检测.在检测PRA之前,根据患者的临床资料不同,分为5组.(1)无既往病史组(1097例):患者既往无输血、妊娠和移植史;(2)单纯输血组(361例):患者曾输血200ml以上;(3)单纯妊娠组(481例):患者曾有妊娠史;(4)输血+妊娠组(294例):患者既有输血史又有妊娠史;(5)再次移植组(196例):患者曾进行过肾移植,但移植肾功能丧失,准备再次进行肾移植. 结果 无既往病史组的男性患者PRA均阴性,仅3例女性患者呈现抗HLAⅡ类抗体弱阳性;单纯输血组共有55例患者PRA阳性,阳性率为15.24%(55/361);单纯妊娠组共有39例患者PRA阳性,阳性率为8.11%(39/481);输血+妊娠组共有90例患者PRA阳性,阳性率为30.61%(90/294);再次移植组共有139例患者PRA阳性,阳性率为70.92%(139/196),且PRA强度＞60%以上的患者有72例. 结论 单纯输血和单纯妊娠可产生PRA,但产生的几率均较低;既输血又妊娠产生PRA的几率大于单纯输血和单纯妊娠的患者;器官移植物刺激产生的抗HLA抗体,无论是在强度上还是在类型上均远远超过了其他抗原的刺激.

Analysis of sensitized factors in 2429 urinemia patients

Objective To analyze the sensitized factors in urinemia patients who waiting for renal transplantation.Methods 2429 patients with urinemia from April 2002 to December 2008 were subjected to the detection of panel reactive antibody, and classified into 5 groups according to their clinical data:(A) no history disease group (n = 1097) who never experienced transfusion, pregnancy and transplantation; (B) Transfusion group (n = 361) who received transfusion more than 200 ml; (C) Pregnancy group (n = 481) who experienced pregnancy; (D) Transfusion+ pregnancy group (n= 294) who experienced both pregnancy and transfusion; (E) Re-transplantation group (n = 196) who experienced failed transplantation before, and waited for the second renal transplantation.Results All the males in group A were negative for PRA, and females were weakly positive for HLA Ⅱ antibody.The incidence of PRA production in group B was 15.24 % (55/361).Thirty-nine patients were positive for PRA in group C with the incidence being 8.11 % (39/481).The PRA positive rate in groups D and E was 30.61 % (90/294) and 70.92 % (139/196) respectively.PRA intensity was more than 60 % in 72 patients in group E.Conclusion Transfusion and pregnancy caused lower incidence of PRA positive rate.The incidence was much higher in transfusion + pregnancy patients than that in patients with transfusion or pregnancy alone.Graft caused the higher incidence of PRA than by transfusion and pregnancy.