[1]董 梅,顾云娜,李兴勤,等.蛋白A免疫吸附清除致敏肾移植受者HLA抗体的临床观察[J].医学信息,2023,36(06):101-105.[doi:10.3969/j.issn.1006-1959.2023.06.022]
　DONG Mei,GU Yun-na,LI Xing-qin,et al.Clinical Observation of the Clearance of HLA Antibodies in Sensitized Renal Transplant Recipients by Protein A Immunoadsorption[J].Journal of Medical Information,2023,36(06):101-105.[doi:10.3969/j.issn.1006-1959.2023.06.022]
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蛋白A免疫吸附清除致敏肾移植受者HLA抗体的临床观察()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年06期
页码:
101-105
栏目:
论著
出版日期:
2023-03-15

文章信息/Info

Title:
Clinical Observation of the Clearance of HLA Antibodies in Sensitized Renal Transplant Recipients by Protein A Immunoadsorption
文章编号:
1006-1959（2023）06-0101-05
作者:
董 梅; 顾云娜; 李兴勤; 等
（昆明市第一人民医院血液净化中心，云南 昆明 650224）
Author(s):
DONG Mei; GU Yun-na; LI Xing-qin; et al.
(Blood Purification Center,the First People’s Hospital of Kunming,Kunming 650224,Yunnan,China)
关键词:
蛋白A免疫吸附; 肾移植; 群体反应性抗体; 高致敏
Keywords:
Protein A immunoadsorption; Renal transplantation; Panel reactive antibody; Highly sensitized
分类号:
R749.1+6
DOI:
10.3969/j.issn.1006-1959.2023.06.022
文献标志码:
A
摘要:
目的 探讨蛋白A免疫吸附治疗对术前群体反应性抗体（PRA）阳性的肾移植受者HLA抗体的清除效果及安全性。方法 选取2017年5月-2018年10月昆明市第一人民医院收治的拟行肾移植术致敏肾移植受者7例为研究对象，治疗方案中均接受蛋白A免疫吸附联合小剂量免疫抑制剂治疗。比较治疗前后免疫球蛋白（IgG、IgA、IgM）、补体（C3、C4）、PRA及HLA抗体MFI值。结果 7例受者共接受27例次蛋白A免疫吸附治疗均未出现不良反应。治疗后IgG、IgA、IgM、C3、C4低于治疗前，差异有统计学意义（P＜0.05）；治疗后、随访1个月PRA-Ⅰ类抗体低于治疗前，且随访1个月PRA-Ⅰ类抗体低于治疗后，差异有统计学意义（P＜0.05），而治疗前后及随访1个月PRA-Ⅱ类抗体比较，差异无统计学意义（P＞0.05）；3例患者治疗前后HLA-Ⅰ类抗体MFI值比较，差异有统计学意义（P＜0.05），2例治疗前后HLA-Ⅱ类抗体MFI值比较，差异有统计学意义（P＜0.05）；其余4例患者治疗前后HLA-Ⅰ、HLA-Ⅱ类抗体MFI值比较，差异无统计学意义（P＞0.05）。结论 蛋白A免疫吸附可以安全有效降低PRA水平和HLA抗体水平。经联合小剂量免疫抑制剂治疗，可使下降的HLA抗体维持至少2周不反弹，为致敏移植患者提供一个相对安全的“窗口期”。
Abstract:
Objective To investigate the effect and safety of protein A immunoadsorption therapy on the clearance of HLA antibodies in renal transplant recipients with positive preoperative panel reactive antibody (PRA).Methods A total of 7 sensitized renal transplant recipients who were admitted to the First People ’s Hospital of Kunming from May 2017 to October 2018 were selected as the study subjects. All patients received protein A immunoadsorption combined with low-dose immunosuppressive therapy. The MFI values of immunoglobulin (IgG, IgA, IgM), complement (C3, C4), PRA and HLA antibody were compared before and after treatment.Results A total of 27 protein A immunoadsorption treatments were performed in 7 recipients without adverse reactions. After treatment, IgG, IgA, IgM, C3 and C4 were lower than those before treatment, and the difference was statistically significant (P<0.05). The PRA-Ⅰ antibody after treatment and 1 month of follow-up was lower than that before treatment, and the PRA-Ⅰ antibody after 1 month of follow-up was lower than that after treatment, the differences were statistically significant (P<0.05). There was no significant difference in PRA-Ⅱ antibody before and after treatment and 1 month of follow-up (P>0.05). The MFI values of HLA-Ⅰ antibody in 3 patients before and after treatment were significantly different (P<0.05), and the MFI values of HLA-Ⅱ antibody in 2 patients before and after treatment were significantly different (P<0.05). There was no significant difference in the MFI values of HLA-Ⅰ and HLA-Ⅱ antibodies before and after treatment in the other 4 patients (P>0.05).Conclusion Protein A immunoadsorption can safely and effectively reduce PRA level and HLA antibody level. Combined with low-dose immunosuppressive therapy, the decreased HLA antibody can be maintained for at least 2 weeks without rebound, providing a relatively safe "window period" for sensitized transplant patients.

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更新日期/Last Update: 1900-01-01