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目的 探讨人类白细胞抗原 (HLA)群体反应性抗体 (PRA)对肾脏移植效果的影响。方法 采用酶联免疫吸附法 (ELISA)和微量补体依赖性细胞毒试验 (CDC)对 897例次肾移植受者的PRA进行动态监测。结果 85 6例初次肾移植受者中术前PRA阳性者 12 1例 ,占 11% ,而 33例次 2次移植和 8例次 3次移植受者术前PRA阳性分别为 5 8%和 87% ,与初次肾移植受者组比较 ,PRA阳性受者比例均显著增高 (P <0 .0 0 1)。PRA阳性组受者肾移植术后排斥发生率为 40 % ,而阴性组受者仅 17% ,两组比较差异有显著性 (P <0 .0 0 1)。PRA阳性组受者的移植物存活率则明显低于阴性组 (P <0 .0 0 1) ,尤其是PRA >40 %的高致敏受者的 1、3、5年和 7年移植物存活率与阴性组比较分别下降了 2 4%、38%、5 7%和 5 6 % ,均为P <0 .0 0 1。ELISA法与CDC法的双盲试验发现 ,319份受者血清中CDC PRA的假阳性和假阴性率分别为 3 .8%和 3 .1%。结论 PRA是预测受者致敏状态的敏感指标 ,对移植后排斥反应和移植物存活率均有明显影响
Objective To investigate the effect of human leukocyte antigen (HLA) group reactive antibody (PRA) on kidney transplantation. Methods The PRA of 897 renal transplant recipients was dynamically monitored by enzyme-linked immunosorbent assay (ELISA) and micro-complement-dependent cytotoxicity assay (CDC). Results Among 856 primary renal transplant recipients, 12 (11%) had preoperative PRA positive and 33 (2) and 8 (3) transplant recipients had preoperative positive PRA of 58% and 87%, respectively %, And the proportion of PRA-positive recipients was significantly higher than that of primary renal transplant recipients (P <0.01). The incidence of rejection after renal transplantation in PRA-positive recipients was 40%, while only 17% in negative recipients. There was significant difference between the two groups (P <0.01). Graft survival rates in PRA-positive recipients were significantly lower than those in the negative group (P <0.001), especially at 1, 3, 5, and 7-year graft survival in highly sensitized recipients with PRA> 40% Compared with the negative group, they decreased by 24%, 38%, 57% and 56% respectively, both P <0.01. Double-blind ELISA and CDC assays found that the false-positive and false-negative rates of CDC PRA in 319 recipients were 3.8% and 3.1%, respectively. Conclusions PRA is a sensitive index for predicting the sensitization status of recipients, which has a significant effect on rejection and graft survival after transplantation