目的 探讨术前C1q结合的供者特异性抗体(C1q+ DSA)预测高致敏肾移植受者术后早期抗体介导排斥反应(AMR)的价值.方法 回顾性分析2012年1月至2014年1月30例术前存在高致敏状态的肾移植受者的临床资料,采用单抗原磁珠法检测受者术前的供者特异性抗体(DSA)和C1q+ DSA,并分析术前DSA和C1q+ DSA与术后早期AMR的关系.结果 术前DSA阳性者22例,其中12例为C1q+ DSA,10例发生AMR(包括3例超急性排斥反应).术前DSA预测术后发生AMR的敏感性100%,特异性为40%,阳性预测值为45.5%,阴性预测值为100%;C1q+ DSA预测AMR的敏感性为100%,特异性为90%,阳性预测值为83.3%,阴性预测值100%.与DSA预测AMR相比,C1q+ DSA的特异性和阳性预测值均显著升高(P<0.01,P<0.05).结论 C1q+ DSA可以预测术后早期AMR的发生,术前区分补体结合的DSA和非补体结合的DSA,避开C1q阳性的抗HLA抗体能增加高致敏患者的移植机会,减少AMR的发生风险.
Objective To investigate the C1q fixing donor specific antibody (C1q+ DSA) predicting antibody-mediated rejection (AMR) early after transplantation in sensitized renal transplantation patients.Method DSA and C1q+ DSA were retrospectively analyzed in 30 highly sensitized renal transplant patients using a Luminex platform from Jan.2012 to Jan.2014 in our hospital.The relationship between preoperative C1q+ DSA and AMR early after transplantation was analyzed.Result DSA was detected in 20 cases before operation,C1q+ DSA in 12 cases,and AMR in 10 cases (including 3 cases of hyperacute rejection).Preoperative C1q+ DSA had a positive predictive value (PPV) of 83.3% and a negative predictive value (NPV) of 100%,with 100% sensitivity and 90% specificity for AMR respectively.C1q+ DSA had higher positive predictive value (83.3% vs.45.5%,P<0.05) and higher specificity (90% vs.40%,P<0.01) than DSA for AMR.Conclusion The C1q assay can detect a sub-set of antibodies capable of fix