论文部分内容阅读
目的:探讨人类白细胞抗原(HLA)-氨基酸残基配型(Res M)标准在致敏患者中的应用。 方法:根据HLA分子结构的氨基酸残基不同,将HLAⅠ类抗原分成10个组, Ⅱ类抗原分成7个组,确定Res M 配型标准;并与标准HLA抗原配型(Ag M)进行比较。回顾性分析Res M对102例致敏患者早期肾功能、急性排斥、术后抗HLA-IgG抗体水平及人/肾存活率的影响。 结果:应用Res M 标准,可明显提高供受者相配概率,0 MM受者由Ag M组1.89%提高到Res M组18.87% (P<0.001) ,0~1MM组受者由9.43%提高到60.37%(P<0.001) ;临床研究结果显示:残基相配的移植肾短期存活率和1、3年长期存活率接近HLA抗原相配水平;与错配组相比,早期移植肾功能延迟恢复发生率、急性排斥反应发生率显著减少,术后抗HLA-IgG抗体水平升高或出现抗供者特异性抗体发生率明显降低,1、3年移植肾存活率明显提高。 结论:HLA-Res M,可大幅度增加供受者的相配概率, 显著降低术后的致敏性,适合在致敏患者肾移植中应用。
Objective: To investigate the application of human leukocyte antigen (HLA) -amino acid residue matching (Res M) standard in patients with sensitization. Methods: HLA class I antigens were divided into 10 groups according to the different amino acid residues of HLA molecule structure. Class II antigens were divided into 7 groups to determine Res M matching standard and compared with standard HLA antigen matching (Ag M). The effect of Res M on early renal function, acute rejection, anti-HLA-IgG antibody level and human / kidney survival rate in 102 patients were retrospectively analyzed. Results: The matching probability of recipients was significantly improved by using Res M standard. The incidence of 0 MM recipients increased from 1.89% in Ag M group to 18.87% in Res M group (P <0.001), while that in 0 ~ 1M group increased from 9.43% to 60.37% (P <0.001). The results of clinical studies showed that the short-term graft survival rate and 1,3-year long-term survival rate of the matched grafts were close to those of HLA antigen. Compared with the mismatch group, delayed graft function recovery Rate of acute rejection reaction significantly reduced the postoperative anti-HLA-IgG antibody levels or the emergence of anti-donor-specific antibody was significantly reduced, 1, 3 years graft survival was significantly improved. Conclusion: HLA-Res M can significantly increase the matching probability of recipients and significantly reduce the postoperative allergenicity, which is suitable for the application of renal transplantation in sensitized patients.