亲属肾移植中母亲—子女之间特殊的免疫学关系研究

发布时间：2018-05-12 15:17

本文选题：亲属肾移植 + 母亲-子女　；参考：《复旦大学》2009年硕士论文

【摘要】： 目的比较不同供受体关系亲属活体肾移植临床疗效,分析受体术后微嵌合体出现率和作用,探索母亲子女之间特殊的免疫学关系对肾移植的影响。方法回顾性分析复旦大学附属中山医院2004年至2008年130例亲属肾移植临床资料,受体随访半年至4年,统计随访结果,采用基本统计方法进行分析。收集受体术后标本,利用STR、HLA-DR位点SSP-PCR和SRY位点SSP-PCR分子生物学方法,检测微嵌合体,并根据随访结果,分析微嵌合体的作用。结果130例受体中共有29例(22.3%)行介入B超下移植肾穿刺活检,病理结果证实20例(母亲作为供体12例,其他关系作为供体8例)有不同程度的急性排斥;临床诊断非病理证实排斥13例(母亲作为供体7例,其他关系作为供体6例)。不同供受体关系比较,母亲-子女肾移植术后受体急性排斥发生率较高,且差别具有统计学意义。43例受体术后不同时间微嵌合体检测中,16例母亲作为供体的受体中,4例检测到微嵌合体,阳性率25%。27例其他关系的受体中,检测到微嵌合体4例,阳性率14.8%。随访结果结果发现9例发生急性排斥,单因素分析微嵌合体存在与否与移植急性排斥发生差别没有统计学意义。结论母亲-子女之间肾移植排斥发生率较高,且受体术后微嵌合体阳性率较高;急性排斥受体体内微嵌合体阳性率较高;尚不能证明微嵌合体在母亲-子女之间移植中可以诱导免疫耐受;母亲-子女之间特殊的免疫学关系可能影响肾移植效果。
[Abstract]:Objective to compare the clinical effects of living donor kidney transplantation with different donor recipients, to analyze the incidence and role of microchimerism after transplantation, and to explore the effect of special immunological relationship between mother and child on renal transplantation. Methods the clinical data of 130 cases of kinship renal transplantation in Zhongshan Hospital affiliated to Fudan University from 2004 to 2008 were retrospectively analyzed. The recipients were followed up for 6 months to 4 years. The microchimerism was detected by the molecular biology method of SSP-PCR and SRY locus SSP-PCR in the HLA-DR locus of the receptor. The effect of the microchimerism was analyzed according to the follow-up results. Results 29 of 130 recipients (22. 3) underwent renal transplantation biopsy under B ultrasound. The pathological results showed that 20 cases (mother as donor 12 cases, other relations as donor 8 cases) had different degrees of acute rejection. 13 cases (7 cases of mother as donor and 6 cases of other relation as donor) were clinically diagnosed as non-pathological rejection. The incidence of acute rejection after mother-child renal transplantation was higher than that of donor recipients. The difference was statistically significant. In 43 cases of microchimerism detected at different time after operation, microchimerism was detected in 4 out of 16 recipients whose mothers were donors. The positive rate of microchimerism was detected in 4 out of 25.27 other related receptors, and the positive rate was 14.8cm. The results of follow-up showed that 9 cases had acute rejection, and there was no significant difference between microchimerism and acute rejection in univariate analysis. Conclusion the incidence of renal allograft rejection between mother and child is higher, and the positive rate of microchimerism is higher after transplantation, and the positive rate of microchimerism in acute rejection recipients is higher. It has not been proved that microchimerism can induce immune tolerance in mother-child transplantation, and the special immunological relationship between mother and child may affect the effect of renal transplantation.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R392

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