【摘要】  目的：探讨人类白细胞抗原 (human leucocyte antigen，HLA)氨基酸残基配型在角膜移植排斥反应中的作用程度，以及术前进行HLA配型的临床意义。方法：角膜移植患者91例92 眼，其中高危角膜50例50 眼，非高危角膜 41例42 眼。HLA-Ⅰ,Ⅱ类抗原分别由一步单抗法和DNA法检测。根据HLA氨基酸残基的相配数分为HLA的低错配组（2错配、3错配）和高错配组（4错配、5错配）。结果：高危组的排斥反应率74.0%明显高于非高危组31.0% (P =0.001)。在高危组中，HLA高错配的排斥反应率高达84.8%，明显高于低错配的52.9% ( P =0.021)，而且高错配组发生排斥反应的危险性是低错配组的1.6倍(RR = 1.6 )。在非高危组中：HLA高错配的排斥反应率30.4%与低错配的31.6%比较无统计学意义（P =0.936）。结论：高危角膜患者HLA高错配组的排斥反应率高于低错配组，术前进行HLA配型有临床指导意义，而对非高危角膜配型无意义。

【关键词】  人类白细胞抗原HLA；氨基酸残基配型；角膜移植

     Clinical application of HLA amino acid residue matching in choice of donor and recipient before keratoplasty

    Mei-Zhu Chen, Yan-Nian Hui

    Department of Ophthalmology, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China

    Abstract AIM: To evaluate the importance of human leucocyte antigen (HLA) amino acid residue matching in keratoplasty before corneal transplantation. METHODS: There were 92 recipient eyes in 92 cases divided into high-risk (50 eyes) and low-risk (42 eyes) groups according to the degree of neovascularization or corneal ulcer with no response to treatment. The cases were subdivided into two groups: high-mismatching (MM) group composed of 4 MM and 5 MM and low-MM group composed of 2 MM and 3MM. HLA-Ⅰ, HLA-Ⅱwere typed by monoclonial antibody and DNA-based method before surgery, respectively. RESULTS: The rejection rate in high-risk (74.0%) was significantly higher than that in low-risk (31.0%), (P=0.001<0.05). In high-risk group, the rejection rate in high-MM group (84.8%) was much higher by 1.6 times than that in low-MM (52.9%) (P=0.021<0.05, RR=1.6). However, in low-risk group there was no significant difference of rejection rate between high-MM (30.4%) and low-MM (31.6%) (P=0.936>0.05). CONCLUSION: The results showed that HLA amino acid residue matching play an important role in reducing rejection rate, indicating that accurate HLA typing is necessary before keratoplasty. If possible, the better matched donor-recipient should be chosen according to the HLA amino acid residue matching especially in high-risk group with severe neovascularization.

    · KEYWORDS: human leucocyte antigen; amino acid residue matching; keratoplasty

     0引言

    多年来角膜移植术后出现的排斥反应严重影响手术效果，大大降低了手术成功率。近年来对我院角膜移植患者，术前检测人类白细胞抗原(human leukocyte antigen ,HLA)，根据供体与受体HLA位点的氨基酸残基相配数目，筛选供受体，术后观察角膜移植片的透明度、免疫排斥反应迹象，探讨角膜移植术后排斥反应的机制，评价HLA氨基酸残基配型在角膜移植中的作用程度及其临床意义。

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