AECAs产生的致敏因素及其与肾移植术后不良事件的相关性分析
发布时间：2019-05-19 06:22
【摘要】：目的:分析肾脏移植受者手术前AECAs阳性的致敏因素,以及探究移植手术前预存的AECAs和移植手术以后新产生的AECAs对受者手术后半年内移植肾脏功能恢复的影响。方法:第一部分,选取了2015年10月至2016年8月在解放军第三0九医院器官移植研究所等候欲行同种异体肾脏移植手术的85位病人为本部分的研究对象。留取病人手术前的血清,同时记录病人的性别、年龄、体重指数、肾脏衰竭原因、替代支持治疗类型及持续时间、手术前肌酐水平、移植史、妊娠史、输血史等临床资料。使用间接免疫荧光法(IIF)检测病人血清中AECAs的表达情况,并根据结果将病人分为AECAs阳性组和AECAs阴性组。检测术前AECAs的阳性率,分析术前致敏史对AECAs产生的影响。第二部分,以第一部分中已行同种异体肾脏移植手术的85位病人为本部分研究对象,留取受者术后1d、3d、7d、15d及1m各时间点血清,采用同第一部分的检测方法检测受者血清中AECAs的表达情况。同时采集受者术后半年内各时间点的血清肌酐水平,并记录DGF、排斥反应、感染等事件的出现情况。依据检测结果将患者分为3组:AECAs(Pre+/Post+)组、AECAs(Pre-/Post+)组和AECAs(Pre-/Post-)组,分析各组AECAs的表达与不良事件发生的相关性。应用IBM SPSS Statistics 20统计软件对数据进行分析,计量资料用均数±标准差(Mean±SD)表示,计量资料之间的比较采用两独立样本t检验或采用单因素方差分析,计数资料之间比较采用χ2检验、校正χ2检验或Fisher确切概率检验,P0.05表示差异有统计学意义。结果:85位等候肾脏移植的病人中,有19位病人手术前外周血AECAs表达阳性,阳性率为22.4%。19位阳性病人中,荧光模型出现3种类型:核周荧光斑块型12例(63.2%),抗细胞骨架抗体型5例(26.3%),抗核抗体型2例(10.5%)。对AECAs阳性组和AECAs阴性组进行分析,两组病人在性别、年纪、体重指数、替代支持治疗类型及持续时间、手术前肌酐水平及原发性疾病等方面没有统计学差异(P0.05)。在输血、妊娠等单独的致敏因素影响下,两组病人仍没有统计学差异(P=0.37;P=0.34)。按致敏史将病人分为致敏组(既往有输血或妊娠史)和非致敏组(既往无输血和妊娠史),致敏组病人28位,其中AECAs阳性病人10位(35.7%),非致敏组病人57位,其中AECAs阳性病人9位(15.8%),既往有致敏经历的患者AECAs阳性率显著高于无致敏经历的患者,两组病人之间存在有明显的统计学差异(χ2=4.295,P=0.038)。85位病人均在我院行同种异体肾脏移植手术,手术前19位AECAs阳性病人在手术后各时间点检测均为阳性,术前66位AECAs阴性病人在术后各时间点检测时有10位病人出现AECAs转阳,其余56位病人手术前及手术后各时间点检测AECAs均为阴性。10位AECAs(Pre-/Post+)患者中,3位病人于手术后的第2-3d出现AECAs,2位病人于手术后的第4-7d出现AECAs,5位病人于手术后的第8-15d出现AECAs。对AECAs(Pre+/Post+)组、AECAs(Pre-/Post+)组和AECAs(Pre-/Post-)组进行比较,3组病人在性别、年龄、体重指数、替代支持治疗类型及持续时间、原发性疾病方面都没有统计学差异(P0.05)。对应的供者类型、性别、年龄、体重指数和供肾的冷缺血时间等也没有统计学差异(P0.05)。在术前诱导方案的应用及术后免疫抑制维持治疗方案上,3组也不存在统计学差异(P0.05)。AECAs(Pre-/Post+)组排斥反应的发生率较其他两组高,AECAs(Pre-/Post+)30%vs AECAs(Pre+/Post+)5.3%vs AECAs(Pre-/Post-)17.9%,但未达到统计学差异(P=0.21)。术后感染的发生情况在3组患者中也没有统计学差异(P=0.31)。但在AECAs(Pre-/Post+)组DGF的发生率(70%)及持续时间(54±42.5d)均明显高于其他两组,差异存在统计学意义(P0.05),并且在肾移植术后1周(P=0.02)、1月(P=0.04)、3月(P=0.01)、6月(P=0.02)时AECAs(Pre-/Post+)组肌酐水平均高于其他两组,差异存在统计学意义。结论:本次研究结果表明(1)术前有移植、输血、妊娠等致敏史的患者AECAs的阳性率会明显增加,且阳性结果类型主要为核周荧光斑块型、抗细胞骨架抗体型和抗核抗体型3种。(2)手术后新产生的AECAs能够增加肾移植手术后移植肾功能延迟恢复(DGF)的发生风险,延长DGF持续时间,影响手术后半年内移植肾功能的恢复。
[Abstract]:Objective: To analyze the sensitization factors of AECAs positive in renal transplant recipients, and to explore the effect of new AECAs on renal function recovery in the first half of the operation of the recipient after the pre-stored AECAs and the transplant operation. Methods: The first part, from October 2015 to August 2016, was selected for the study of 85 patients at the Institute of Organ Transplantation in the third 0-9 hospital of the People's Liberation Army (PLA) for the purpose of this part. Clinical data such as sex, age, body weight index, kidney failure reason, alternative support treatment type and duration, pre-operative myocardiac level, transplant history, pregnancy history, and blood transfusion history were recorded. The expression of AECAs in serum of patients was detected by indirect immunofluorescence (IIF), and the patients were divided into AECAs positive group and AECAs negative group according to the results. The positive rate of AECAs before operation was detected, and the effect of preoperative sensitization history on AECAs was analyzed. In the second part,85 patients with the same allogenic kidney transplantation in the first part were the subject of the partial study, and the serum levels of AECAs in the recipient's serum were detected by the detection method of the same first part. At the same time, the level of serum myoglobin in each time point within six months of the recipient was collected, and the occurrence of the events such as DGF, rejection and infection was recorded. The patients were divided into three groups: AECAs (Pre +/ Post +) group, AECAs (Pre-/ Post +) group and AECAs (Pre-/ Post-) group according to the detection results, and the correlation between the expression of AECAs and the adverse events was analyzed. The data is analyzed by using the statistical software of the IBM SPSS Statistics 20. The mean square standard deviation (Mean-SD) is used for the measurement data. The two independent samples t are used for the comparison between the measurement data and the one-factor analysis of variance is adopted. The correction factor 2 test or the Fisher's exact probability test, P0.05, indicates that the difference is of statistical significance. Results: The expression of AECAs in the peripheral blood of 85 patients with renal transplantation was positive, and the positive rate was 22.4%. Among the 19 positive patients,3 types were observed in the fluorescence model:12 (63.2%) of the nuclear-week fluorescent plaque and 5 (26.3%) of the anti-cytoskeleton antibody. 2 cases of anti-nuclear antibody (10.5%). The positive group of AECAs and the negative group of AECAs were analyzed, and there was no statistical difference between the two groups in terms of sex, age, body weight index, alternative support treatment type and duration, pre-operative myocardiac level and primary disease (P0.05). There was no statistical difference between the two groups (P = 0.37; P = 0.34) under the influence of individual sensitization factors such as blood transfusion, pregnancy and the like. The patient was divided into a sensitizing group (with a history of blood transfusion or pregnancy) and a non-sensitizing group (a history of no previous blood transfusion or pregnancy) and a non-sensitizing group (prior to the history of no blood transfusion and pregnancy) according to the sensitive history, with 28 patients in the sensitization group, of which 10 (35.7%) of the AEAs-positive patients and 57 in the non-sensitizing group, of which 9 (15.8%) of the AECAs-positive patients, The positive rate of AECAs in patients with prior sensitization was significantly higher than those with no sensitization, and there was a significant difference between the two groups (Sup2 = 4.295, P = 0.038). The 19 AECAs positive patients were positive at all time after the operation, and the patients with AECAs were positive at all time points after operation, and there were 10 patients with AECAs turned positive at each time point after operation. AECAs were detected in the remaining 56 patients before and after operation and at all time points after the operation. In the 10 AECAs (Pre-/ Post +) patients,3 patients had AECAs in the second to third day after the operation, and 2 patients had AECAs on the 4th to 7th day after the operation, and the 5 patients had AECAs on the 8th to 15th day after the operation. Compared with the AECAs (Pre-/ Post +) group, AECAs (Pre-/ Post +) group and AECAs (Pre-/ Post-) group, there was no statistical difference in the three groups in terms of sex, age, body weight index, alternative support treatment type and duration, and primary disease (P0.05). There was no statistical difference between the corresponding donor type, sex, age, body weight index and cold ischemia time for the kidney (P0.05). There was no statistical difference in 3 groups (P0.05). The rate of rejection of AECAs (Pre-/ Post +) group was higher than that of other two groups, and the rate of AECAs (Pre-/ Post +)30% vs. AECAs (Pre +/ Post +) 5.3% vs. AECAs (Pre-/ Post-) was 17.9%, but no statistical difference was achieved (P = 0.21). The incidence of post-operative infection was also not statistically different in the 3 patients (P = 0.31). However, the incidence of DGF (70%) and duration (54-42.5 d) in the AECAs (Pre-/ Post +) group were significantly higher than those in the other two groups (P = 0.02),1 month (P = 0.04),3 months (P = 0.01), and 6 months (P = 0.02), and the level of the APCs (Pre-/ Post +) group was higher than that of the other two groups. There was a statistically significant difference in the difference. Conclusion: The results of this study show that (1) The positive rate of AECAs in patients with pre-operation, transfusion, pregnancy and so on is significantly increased, and the positive result type is mainly the nuclear-week fluorescent plaque type, the anti-cytoskeleton antibody type and the anti-nuclear antibody type 3. (2) The newly-generated AECAs after operation can increase the risk of delayed recovery of renal function after renal transplantation (DGF), prolong the duration of DGF, and affect the recovery of transplanted kidney function within half a year after operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
本文编号：2480466
[Abstract]:Objective: To analyze the sensitization factors of AECAs positive in renal transplant recipients, and to explore the effect of new AECAs on renal function recovery in the first half of the operation of the recipient after the pre-stored AECAs and the transplant operation. Methods: The first part, from October 2015 to August 2016, was selected for the study of 85 patients at the Institute of Organ Transplantation in the third 0-9 hospital of the People's Liberation Army (PLA) for the purpose of this part. Clinical data such as sex, age, body weight index, kidney failure reason, alternative support treatment type and duration, pre-operative myocardiac level, transplant history, pregnancy history, and blood transfusion history were recorded. The expression of AECAs in serum of patients was detected by indirect immunofluorescence (IIF), and the patients were divided into AECAs positive group and AECAs negative group according to the results. The positive rate of AECAs before operation was detected, and the effect of preoperative sensitization history on AECAs was analyzed. In the second part,85 patients with the same allogenic kidney transplantation in the first part were the subject of the partial study, and the serum levels of AECAs in the recipient's serum were detected by the detection method of the same first part. At the same time, the level of serum myoglobin in each time point within six months of the recipient was collected, and the occurrence of the events such as DGF, rejection and infection was recorded. The patients were divided into three groups: AECAs (Pre +/ Post +) group, AECAs (Pre-/ Post +) group and AECAs (Pre-/ Post-) group according to the detection results, and the correlation between the expression of AECAs and the adverse events was analyzed. The data is analyzed by using the statistical software of the IBM SPSS Statistics 20. The mean square standard deviation (Mean-SD) is used for the measurement data. The two independent samples t are used for the comparison between the measurement data and the one-factor analysis of variance is adopted. The correction factor 2 test or the Fisher's exact probability test, P0.05, indicates that the difference is of statistical significance. Results: The expression of AECAs in the peripheral blood of 85 patients with renal transplantation was positive, and the positive rate was 22.4%. Among the 19 positive patients,3 types were observed in the fluorescence model:12 (63.2%) of the nuclear-week fluorescent plaque and 5 (26.3%) of the anti-cytoskeleton antibody. 2 cases of anti-nuclear antibody (10.5%). The positive group of AECAs and the negative group of AECAs were analyzed, and there was no statistical difference between the two groups in terms of sex, age, body weight index, alternative support treatment type and duration, pre-operative myocardiac level and primary disease (P0.05). There was no statistical difference between the two groups (P = 0.37; P = 0.34) under the influence of individual sensitization factors such as blood transfusion, pregnancy and the like. The patient was divided into a sensitizing group (with a history of blood transfusion or pregnancy) and a non-sensitizing group (a history of no previous blood transfusion or pregnancy) and a non-sensitizing group (prior to the history of no blood transfusion and pregnancy) according to the sensitive history, with 28 patients in the sensitization group, of which 10 (35.7%) of the AEAs-positive patients and 57 in the non-sensitizing group, of which 9 (15.8%) of the AECAs-positive patients, The positive rate of AECAs in patients with prior sensitization was significantly higher than those with no sensitization, and there was a significant difference between the two groups (Sup2 = 4.295, P = 0.038). The 19 AECAs positive patients were positive at all time after the operation, and the patients with AECAs were positive at all time points after operation, and there were 10 patients with AECAs turned positive at each time point after operation. AECAs were detected in the remaining 56 patients before and after operation and at all time points after the operation. In the 10 AECAs (Pre-/ Post +) patients,3 patients had AECAs in the second to third day after the operation, and 2 patients had AECAs on the 4th to 7th day after the operation, and the 5 patients had AECAs on the 8th to 15th day after the operation. Compared with the AECAs (Pre-/ Post +) group, AECAs (Pre-/ Post +) group and AECAs (Pre-/ Post-) group, there was no statistical difference in the three groups in terms of sex, age, body weight index, alternative support treatment type and duration, and primary disease (P0.05). There was no statistical difference between the corresponding donor type, sex, age, body weight index and cold ischemia time for the kidney (P0.05). There was no statistical difference in 3 groups (P0.05). The rate of rejection of AECAs (Pre-/ Post +) group was higher than that of other two groups, and the rate of AECAs (Pre-/ Post +)30% vs. AECAs (Pre +/ Post +) 5.3% vs. AECAs (Pre-/ Post-) was 17.9%, but no statistical difference was achieved (P = 0.21). The incidence of post-operative infection was also not statistically different in the 3 patients (P = 0.31). However, the incidence of DGF (70%) and duration (54-42.5 d) in the AECAs (Pre-/ Post +) group were significantly higher than those in the other two groups (P = 0.02),1 month (P = 0.04),3 months (P = 0.01), and 6 months (P = 0.02), and the level of the APCs (Pre-/ Post +) group was higher than that of the other two groups. There was a statistically significant difference in the difference. Conclusion: The results of this study show that (1) The positive rate of AECAs in patients with pre-operation, transfusion, pregnancy and so on is significantly increased, and the positive result type is mainly the nuclear-week fluorescent plaque type, the anti-cytoskeleton antibody type and the anti-nuclear antibody type 3. (2) The newly-generated AECAs after operation can increase the risk of delayed recovery of renal function after renal transplantation (DGF), prolong the duration of DGF, and affect the recovery of transplanted kidney function within half a year after operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2
【参考文献】
相关期刊论文 前1条
1 金茜;杜博;孙文英;李兴库;;抗内皮细胞抗体在肾移植慢性排斥反应中的作用[J];国际免疫学杂志;2013年01期
，本文编号：2480466
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