液态芯片技术检测抗人类白细胞抗原抗体抗主要组织相容性Ⅰ类相关链A位点抗体在移植肾围手术期急性抗体介导性排斥反应中的应用
|
摘要
目的探讨液态芯片技术(Luminex)检测移植肾受者围手术期发生急性抗体介导性排斥反应者抗人类白细胞抗原(HLA)抗体、抗主要组织相容性Ⅰ类相关链A位点(MICA)抗体水平与影响。方法选取我院器官移植研究所2008年1月至2013年6月肾移植术后围手术期患者106例为研究对象,采用Luminex技术检测接受同种异体肾移植手术并明确病理诊断肾围手术期急性抗体介导性排斥反应患者血清中抗HLA抗体、抗MICA抗体,并同步检测血肌酐、尿量及移植肾超声等临床指标。结果参照Banff 2007标准组织病理学诊断移植肾超急性排斥反应2例,急性抗体介导性排斥反应15例,同时应用Luminex方法检测抗HLA抗体、抗MICA抗体水平,HLA抗体检测结果15例阳性,阳性率为88%(15/17),检出PRAⅠ类和Ⅱ类阳性率分别为47%(7/15)和53%(8/15);MICA抗体2例阳性,阳性率为12%(2/17),其余89例其他病理类型检测未见抗HLA抗体、MICA抗体阳性,移植肾穿刺病理结果显示HLA抗体、抗MICA抗体阳性患者C4d沉积均为阳性。结论抗HLA抗体、抗MICA抗体可预测围手术期急性抗体介导性排斥反应发生及治疗效果,对于及时诊断及治疗排斥反应提供了一个重要指标,可影响移植肾的长期存活。
Objective To study of Luminex technique for the detection of level of anti HLA antibody,anti MICA antibody in renal transplantation acute antibody mediated rejection in peri operation period and their influence.Methods One hundred and six renal allograft biopsies were performed.All biopsies were systematically diagnosed and evaluated according to the Banff 2007 schema.Luminex was used to detect serum anti HLA antibody,anti MICA antibody in the peri operation period of patients with acute antibody mediated rejection reaction,and renal blood creatinine,urine volume and renal ultrasound and other clinical indicators were synchronously detected.Results Two cases of hyperacute rejection and 15 cases of acute antibody mediated rejection were detected among106 cases of renal transplantation according to histopathological diagnosis.The results showed 15 cases of HLA antibody were positive,the positive rate was 88%,in which positive rates of PRA ⅠandⅡ were 47%and 53%,respectively,and 2cases of MICA antibody were positive,the positive rate was 12% by Luminex method.Furthermore,immunohistochemical staining of C4 dwere also positive in these cases.While the same results were not detected in other 89 cases.Conclusion Anti HLA antibody and anti MICA antibody could be used as the important indicators to predict the occurrence and treatment effect of peri operation period of acute antibody mediated rejection and to ensure the long-term survival of transplanted kidney.
Objective To study of Luminex technique for the detection of level of anti HLA antibody,anti MICA antibody in renal transplantation acute antibody mediated rejection in peri operation period and their influence.Methods One hundred and six renal allograft biopsies were performed.All biopsies were systematically diagnosed and evaluated according to the Banff 2007 schema.Luminex was used to detect serum anti HLA antibody,anti MICA antibody in the peri operation period of patients with acute antibody mediated rejection reaction,and renal blood creatinine,urine volume and renal ultrasound and other clinical indicators were synchronously detected.Results Two cases of hyperacute rejection and 15 cases of acute antibody mediated rejection were detected among106 cases of renal transplantation according to histopathological diagnosis.The results showed 15 cases of HLA antibody were positive,the positive rate was 88%,in which positive rates of PRA ⅠandⅡ were 47%and 53%,respectively,and 2cases of MICA antibody were positive,the positive rate was 12% by Luminex method.Furthermore,immunohistochemical staining of C4 dwere also positive in these cases.While the same results were not detected in other 89 cases.Conclusion Anti HLA antibody and anti MICA antibody could be used as the important indicators to predict the occurrence and treatment effect of peri operation period of acute antibody mediated rejection and to ensure the long-term survival of transplanted kidney.
引文
[1]韩永,黄海燕,许晓光,等.移植肾穿刺组织病理学检查及临床分析[J].中华实用诊断与治疗杂志,2010,24(12):1173-1178.
[2]韩永,郭晖,蔡明,等.移植肾活检:病理及组织学的早期诊断价值[J].中国组织工程研究,2013,17(5):785-790.
[3]Bahram S,Spies T.Nucleotide sequence of a human MHC class I MICB cDNA[J].Immunogenetics,1996,43(4):230-233.
[4]Zou Y,Heinemann FM,Grosse-Wilde H,et al.Detection of anti-MICA antibodies in patients awaiting kidney transplantation,during the post-transplant course,and in eluates from rejected kidney allografts by Luminex flow cytometry[J].Hum Immunol,2006,67(3):230-237.
[5]向雪宝.肾移植围手术期目标导向性液体治疗进展[J].器官移植,2014,5(3):191-193.
[6]王庆华,谭建明,王英,等.HLA配型对群体反应性抗体阳性的肾移植受者人/肾存活率的影响[J].中华器官移植杂志,2007,28(12):728-730.
[7]Schroeder MA,Blum W.Evidence-based mini-review:should patients over the age of 60with INT-2or high-risk myelodysplastic syndrome undergo allogeneic stem cell transplantation prior to progression to acute myelogenous leukemia?[J].Hematol Am Soc Hematol Educ Prog,2010,2010:322-324.
[8]Othman MM,Ismael AZ,Hammouda GE.The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation[J].Anesth Analg,2010,110(5):1440-1446.
[9]Paantjens AW,van de Graaf EA,Kwakkel-van EJ,et al.The induction of IgM and IgG antibodies against HLA or MICA after lung transplantation[J].Pulm Med,2011,2011:432169.
[10]Ranjan P,Nada R,Jha V,et al.The role of C4dimmunostaining in the evaluation of the causes of renal allograft dysfunction[J].Nephrol Dial Transpl,2008,23(5):1735-1741.
[11]Terasaki PI,Ozawa M,Castro R.Four-year follow-up of a prospective trial of HLA and MICA antibodies on kidney graft survival[J].Am J Transplant,2007,7(2):408-415.
[12]Singh N,Djamali A,Lorentzen D,et al.Pretransplant donor-specific antibodies detected by single-antigen bead flow cytometry are associated with inferior kidney transplant outcomes[J].Transplantation,2012,90(10):1079-1084.
[13]石炳毅.应进一步提高肾脏移植排斥反应的无创诊断水平[J].中华医学杂志,2011,91(48):3385-3387.
[2]韩永,郭晖,蔡明,等.移植肾活检:病理及组织学的早期诊断价值[J].中国组织工程研究,2013,17(5):785-790.
[3]Bahram S,Spies T.Nucleotide sequence of a human MHC class I MICB cDNA[J].Immunogenetics,1996,43(4):230-233.
[4]Zou Y,Heinemann FM,Grosse-Wilde H,et al.Detection of anti-MICA antibodies in patients awaiting kidney transplantation,during the post-transplant course,and in eluates from rejected kidney allografts by Luminex flow cytometry[J].Hum Immunol,2006,67(3):230-237.
[5]向雪宝.肾移植围手术期目标导向性液体治疗进展[J].器官移植,2014,5(3):191-193.
[6]王庆华,谭建明,王英,等.HLA配型对群体反应性抗体阳性的肾移植受者人/肾存活率的影响[J].中华器官移植杂志,2007,28(12):728-730.
[7]Schroeder MA,Blum W.Evidence-based mini-review:should patients over the age of 60with INT-2or high-risk myelodysplastic syndrome undergo allogeneic stem cell transplantation prior to progression to acute myelogenous leukemia?[J].Hematol Am Soc Hematol Educ Prog,2010,2010:322-324.
[8]Othman MM,Ismael AZ,Hammouda GE.The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation[J].Anesth Analg,2010,110(5):1440-1446.
[9]Paantjens AW,van de Graaf EA,Kwakkel-van EJ,et al.The induction of IgM and IgG antibodies against HLA or MICA after lung transplantation[J].Pulm Med,2011,2011:432169.
[10]Ranjan P,Nada R,Jha V,et al.The role of C4dimmunostaining in the evaluation of the causes of renal allograft dysfunction[J].Nephrol Dial Transpl,2008,23(5):1735-1741.
[11]Terasaki PI,Ozawa M,Castro R.Four-year follow-up of a prospective trial of HLA and MICA antibodies on kidney graft survival[J].Am J Transplant,2007,7(2):408-415.
[12]Singh N,Djamali A,Lorentzen D,et al.Pretransplant donor-specific antibodies detected by single-antigen bead flow cytometry are associated with inferior kidney transplant outcomes[J].Transplantation,2012,90(10):1079-1084.
[13]石炳毅.应进一步提高肾脏移植排斥反应的无创诊断水平[J].中华医学杂志,2011,91(48):3385-3387.