摘要目的 研究肾移植患者术前输血与再次移植导致抗体生成的机率.方法 自2002年4月～2006年12月共检测了肾移植前1810例患者群体反应性抗体,其中输血200 mL以上患者509人,男性185人,女性324人;再移植患者136人,男性93人,女性43人.PRA检测采用美国One lanmbda公司和美国GTI公司提供的ELISA筛选人类白细胞抗原(human leucocyte antigen,HLA-Ⅰ),类、HLA-Ⅱ类混合抗原板.鉴定抗体类型采用采用美国One lanmbda公司鉴定抗原板(LAT-1240).结果 移植前输血患者509例,88例PRA阳性,占输血人数的17.28%,其中男性患者占4.32%,女性患者占12.97%.再次移植前患者136例,97例PRA阳性,占71.32%;其中男性患者占50%,女性患者占21.32%.肾移植术前输血患者PRA出现机率较高的抗HLA-Ⅰ类抗体有抗HLA-A1、A2、A3、A11和A24抗体;抗HLA-B13、1327、B60、B22、B51和B17.抗HLAII类抗体在输血患者中未能检测出较高反应抗体.再次移植前患者PRA出现机率较高的抗HLA-Ⅰ类抗体有抗HLA-A2、A11和A24抗体;抗HLA-B13、B5和B40.抗HLA-Ⅱ类抗体出现机率较高有抗HLA-DR1、4、7、8、15抗体.结论 再次移植前患者产生抗HLA-抗体的机率高于肾移植术前输血患者,而且产生的抗HLA强度和类型比输血患者更复杂,因此再次移植患者术后更易发生排斥反应.

abstractsObjective To compare the incidence of HLA antibody production between transfusion and second renal transplant ation.Methods A total of 1810 patients were tested panel reactive antibody(PRA,April.2002-December 2006)before renal transplant,509 patients experienced 200 mL blood transfusion,185 males,324 females;136 patients experienced second renal transplant ation,93 males,43 females.PRA was screened using HLA-Ⅰ and HLA-Ⅱ antigen tray(One lanmbda;GTI),PRA type was identified using One lanmbda LAT-1240.Result 509 patients experienced transfusion,88 patients showed PRA positive (17.28%),4.32%male,12.97%female.136 second renal transplant ation patients,97 showed PRA positive(71.32%),male 50.0%,female 21.32%.Transfusion caused higher PRA incidence.High incidence HLA-Ⅰ antibodies were A1,A2,A3,A11,A24;B13,B27,B60,B22,B51,B17.No high incidence HLA-Ⅱ antibody werefound.High incidence HLA-Ⅰ and Ⅱ antibodies were A2,A11,A24;B13,135,B40 and DRI,DR4,DR7,DR8,DR15 in second renal transplant patients.Conclusion The incidence of PRA production was higher in second renal transplant patients than that in blood transfusion patients,what's more,HLA antibody intensity and type were much more complicated,that's why second transplant caused rejection more easily.