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目的分析群体反应性抗体(PRA)监测对预测肾移植受者排斥反应发生的意义及探讨对高水平PRA受者的临床处理。方法应用酶联免疫吸附分析法(ELISA法)动态监测肾移植受者的PRA水平,以PRA≥10%为阳性,10%≤PRA<50%为低致敏、PRA≥50%为高致敏,并对37例术前高致敏患者行血浆置换。结果1527例肾移植受者中,PRA阳性350例(22.9%),其中高致敏94例(26.8%);PRA阳性组排斥反应发生率(21.1%)高于PRA阴性组(3.8%,P<0.01),术后PRA转为阳性组排斥反应发生率高于PRA无变化组(P<0.01),行血浆置换受者与未行血浆置换受者排斥反应发生率无差异(P>0.05),接受过移植、多次妊娠、多次输血受者易致敏,HLA-A、B、DR配型错配抗原>3个受者急性排斥的发生率(16.9%)明显高于错配抗原≤3个受者(1.7%,P<0.01)。结论动态监测PRA水平有助于预测排斥反应的发生。
OBJECTIVE: To analyze the significance of population reactive antibody (PRA) surveillance in predicting rejection in renal transplant recipients and to explore the clinical management of high-level PRA recipients. Methods The level of PRA in renal transplant recipients was dynamically monitored by enzyme-linked immunosorbent assay (ELISA). PRA≥10% was positive, 10% ≤PRA <50% was hypoallergenic, PRA≥50% was hypersensitive, and 37 cases of preoperative hypersensitivity in patients with plasma exchange. Results Among 1527 renal transplant recipients, PRA was positive in 350 cases (22.9%), of which 94 cases were hypersensitive (26.8%). The incidence of rejection in PRA positive group (21.1%) was higher than that in PRA negative group (3.8%, P <0.01) ). The incidence of rejection after PRA turned positive was higher than that of PRA (P <0.01). There was no difference in the incidence of rejection between plasma exchange recipients and non-plasma exchange recipients (P> 0.05) The incidence of acute rejection (16.9%) of HLA-A, B, DR mismatched antigen> 3 recipients was significantly higher than that of mismatched antigen ≤3 Recipients (1.7%, P <0.01). Conclusions The dynamic monitoring of PRA level can help predict the occurrence of rejection.