Abstract:

Objective To investigate the characteristics of major histocompatibility complex class Ⅰ associated chain A （MICA） antibody in recipients after renal transplantation and its relationship with the pathological status of the transplanted kidneys. Methods The data of 355 patients from the Department of Kidney Transplantation at the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to December 2023 were retrospectively analyzed. According to the pathological diagnosis results of the transplanted kidneys， they were divided into rejection group（ 76 cases）， non-rejection group（ 54 cases）， and stable renal function group （225 cases）. Statistical analysis was performed using GraphPad Prism 9.0 statistical software. Results Among 355recipients， 18.3%（ 65 cases） were positive for MICA antibodies， and there was no correlation with HLA antibodies （r ＝ -0.202 7，P ＝ 0.1980）. There were significant differences in common MICA antibodies between rejection group，non-rejection group and stable renal function group. The multiples of MFI and threshold of MICA antibody in the rejection group were generally higher than those in the non-rejection group and the renal function stable group， especially MICA*009， MICA*004 and MICA*002（ P ＜ 0.000 1）. Receiver operating characteristic curve（ ROC） analysis found that MICA antibody has high diagnostic value in predicting interstitial inflammation〔（area under curve）AUC ＝ 0.8201〕and angiitis（ AUC ＝ 0.814 1） in acute renal allograft lesions，interstitial fibrosis（AUC ＝ 0.819 7） and tubular atrophy（ AUC ＝ 0.839 9） in chronic renal allograft nephropathy. The ability to predict antibodymediated rejection（ ABMR） was stronger than that of T-cell-mediated rejection（ TCMR）（ overall rejection ： AUC ＝ 0.688 5 ；ABMR ： AUC ＝ 0.603 8 ；TCMR ： AUC ＝ 0.542 3）. Conclusion The MICA antibody was different in rejection， non-rejection and stable renal function recipients after renal transplantation. MICA antibody has high value in predicting tubulointerstitial disease in transplanted kidneys， and its value in predicting ABMR is higher than that in predicting TCMR. 

Key words:

Renal transplantation, MICA antibodies, Rejection

摘要：

目的 探讨肾移植术后受者主要组织相容性复合体Ⅰ类相关链 A（ major histocompatibility complex Class I associated chain A，MICA）抗体特征及其与移植肾脏病理表现的关系。 方法 本研究回顾 性分析了西安交通大学第一附属医院肾移植科 2016 年 1 月至 2023 年 12 月的 355 例患者资料，根据移植 肾脏病理诊断结果分为排斥反应组（n ＝ 76）、非排斥反应组（n ＝ 54）、肾功能稳定组（n ＝ 225）。应用 GraphPad Prism 9.0 统计软件进行统计学分析。结果 355 例受者中，MICA 抗体阳性为 18.3%（65 例），与 人类白细胞抗原（human leukocyte antigen，HLA）抗体无相关关系（r ＝ -0.2027，P ＝ 0.1980）。排斥反应组、 非排斥反应组及肾功能稳定组之间常见的 MICA 抗体存在显著差异。排斥反应组的 MICA 抗体 MFI 值与抗 体倍数显著高于非排斥反应组和肾功能稳定组，尤其是 MICA*009、MICA*004、MICA*002（P ＜ 0.0001）。 受试者工作特征曲线（receiver operating characteristic curve，ROC）分析发现，MICA 抗体预测移植肾急性 病变中的间质炎〔曲线下面积（area under curve，AUC）＝ 0.8201〕、小管炎（AUC ＝ 0.8141）和慢性移植 肾病变中的间质纤维化（AUC ＝ 0.8197）、肾小管萎缩（AUC ＝ 0.8399）诊断价值较高。预测抗体介导排 斥反应（antibody-mediated rejection，ABMR）的能力强于 T 细胞介导排斥反应（T-cell-mediated rejection， TCMR）（总体排斥反应 ：AUC ＝ 0.6885 ；ABMR ：AUC ＝ 0.6038 ；TCMR ：AUC ＝ 0.5423）。 结论 肾移 植术后排斥、非排斥反应受者及移植肾功能稳定受者常见的 MICA 抗体不同。MICA 抗体对移植肾肾小管间 质病变的预测价值高，对抗体介导性排斥反应的预测价值显著高于对 T 细胞介导排斥反应。 

关键词:

肾移植 , 主要组织相容性复合体Ⅰ类相关链 A 抗体 , 排斥反应