供体特异性输血与嵌合体发生及肾移植急性排斥反应的关系

doi:国家自然科学基金资助课题；中国博士后基金

供体特异性输血与嵌合体发生及肾移植急性排斥反应的关系

张志宏¹，那万里²，傅耀文²，岗崎肇³，肖连升²，郭应禄¹

1. 北京大学第一医院泌尿外科北京大学泌尿外科研究所，北京100034；2.吉林大学中日联谊医院泌尿外科，吉林长春130031；3. 日本仙台社会保险病院外科，宫城仙台981-0933

收稿日期:2003-08-01 修回日期:1900-01-01 出版日期:2004-05-28 发布日期:2004-05-28

Relationship between chimerism and donor-specifictransfusion and acute kidney transplantion rejection

ZHANG Zhi-hong¹, NA Wan-li², FU Yao-wen², Okazaki Hajime³, XIAO Lian-sheng²,GUO Ying-lu¹

1.Department of Urology, First Hospital, Institute of Urology, Peking University, Beijing 100034,China; 2.Department of Urology,China-Japan Union Hospital,Jilin University,Changchun 130031,China;3.Department of Surgery, Sendai Shakaihoken Hospital, Sendai Japan 981-0933

Received:2003-08-01 Revised:1900-01-01 Online:2004-05-28 Published:2004-05-28

摘要/Abstract

摘要： 目的：研究供体特异性输血(DST)患者末梢血中嵌合体的发生及其与肾移植急性排斥反应的关系。方法：肾移植患者60例，分为：A组，未行DST 的尸体肾移植35 例(2 or 3 HLA-mismatched)；B组，未行DST的活体肾移植3例，HLA配型各位点无错配；C组，术前行DST 的活体肾移植22例(1 or 2 HLA-mismatched)，利用PCR-SSP法检测患者末梢血中的HLA-DRB1基因。结果：A组12例(34.3%)、B组3例(100%)、C组19例(86.3%)发现了供体的HLA-DRB1基因，证实有嵌合体发生。在34例有嵌合体发生的病例中14例(41.2%)、26例无嵌合体存在的病例中有10例(38.5%)发生过急性排斥反应，但两组间比较差异无显著性(P>0.05), 同时排斥反应发生的频率、次数比较差异也无显著性(P>0.05)。另外，C组病例中嵌合体现象消失，PCR-SSP检测转为阴性时未见排斥反应病例发生。结论：DST 有利于促进嵌合体的形成，嵌合体现象与急性排斥反应间无相关性，不能以嵌合体现象的有无作为诊断急性排斥反应的依据。

关键词: 嵌合体, 移植物排斥, 肾移植, 输血

Abstract: Objective To study the relationship between chimerism of peripheral blood and donor-specific transfusion (DST) and acute kidney transplantion rejection. Methods The subjects were divided into 3 groups: group A, 35 subjects with corpse donor kidney transplantation who did not undertake DST before operation (2 or 3 HLA-mismatched); group B, 3 subjects with live donor kidney transplantation who did not undertake DST before operation (none was HLA-mismatched); group C, 22 subjects who undertook DST before operation (1 or 2 HLA-mismatched). PCR-SSP was used to check the HLA-DRB1 gene in peripheral blood. Results 12 subjects (34.3%) in group A, 3 subjects (100%) group B and 19 subjects (86.3%) in group C were found donor HLA-DRB1 gene. Chimerism was confirmed. 41.2% (14/34) subjects with chimerism and 38.5% (10/26) subjects without chimerism were found acute rejection,but there was no significant difference between two groups (P>0.05), as well as the frequency and times of rejction. Moreover, chimerism disppeared in all cases in group C and there was no rejection. Conclusion DST can lengthen the survival of the donor kidney by improving the formation of micro-chimerism. There is no accountable relationship between the disappearance of chimerism and acute rejection.

Key words: chimera, graft rejection, kidney transplantation, blood transfusion

中图分类号:

R692

张志宏，那万里，傅耀文，岗崎肇，肖连升，郭应禄. 供体特异性输血与嵌合体发生及肾移植急性排斥反应的关系[J]. J4, 2004, 30(3): 434-436.

ZHANG Zhi-hong, NA Wan-li, FU Yao-wen, Okazaki Hajime, XIAO Lian-sheng,GUO Ying-lu. Relationship between chimerism and donor-specifictransfusion and acute kidney transplantion rejection[J]. J4, 2004, 30(3): 434-436.

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