中文摘要：

目的研究肾移植受者术前血清抗内皮细胞抗体（AECA）的水平对术后6个月内发生急性排斥（AR）的预测作用。方法将1998年12月至2003年8月在本中心行同种异体肾移植并存有血标本的495例受者纳入研究。回顾总结术后6个月内AR发生情况及相关资料。健康对照（阴性对照）40例。采用细胞一ELISA法，以EA.hy926细胞（人脐静脉内皮细胞株）为底物榆测血清AECA水平。结果采用比值表示，P（患者）／N（阴性对照）=（A患者标本—A空自对照）/（A阴性对照—A空自对照）。P／N大于健康对照组均值加2个标准差者为阳性。结果495例患者血清中，AECA阳性93例（18.8％）。维持血透时间大于12个月患者血清AECA水平（1.43±0.37）显著高于未透析患者（1.27±0.32，P=0.013）及维持血透时间≤12个月患者（1.31±0.32，P=0.029）。血清AECA水平与透析时间呈正相关（r=0.218，P=0.018）。AECA阴性、阳性患者术后6个月内AR发生率分别为23.4％、38.7％，差异有统计学意义（P=0.002）。AECA阳性患者细胞性AR、体液性AR的发生率均显著升高（P=0.035，P=0.002）。多元Logistic回归分析显示AECA阳性、群体反应性抗体（PRA）≥10％、高淋巴毒反应为发生AR的独立危险囚素，优势比（OR）分别为2.056、1.751、1.764（P值分别为0.004、0.029、0.050）。结论肾移植受者术前血清AECA阳性预示术后发生急性排斥反应的风险增加：术前血清AECA水平随透析时间延长而升高。

英文摘要：

Objective To study the pre-transplant serum level of anti-endothelial cell antibody （AECA） in kidney allograft recipients and its impact on the episode of acute rejection （AR） within 6 months after transplantation. Methods A total of 495 kidney allograft recipients with pre-transplant serum between December 1998 and August 2003 in our center and 40 healthy controls（negative controls）were enrolled in the study. Clinical data including AR within 6 months after transplantation were analyzed retrospectively. The serum AECA level was measured by cyto-ELISA using EA.hy926 cells as substrate, which was shown as the ratio of P （patient）/N （negative control）=（Apatient—Abalnk control）/（Anegative control—Abalnk control）. AECA was considered positive when PIN value was greater than the average Anegative control value plus two times the standard deviation. Results Positive rate of AECA was 18.8%（93/495）. AECA level in hemodialysis patients who had been on hemodialysis more than 12 months was 1.43±0.37, greater than those less than 12 months （1.27±0.32, P=0.013） and those of non-dialyzed patients （1.31±0.32, P=0.029）. Correlation coefficient between AECA level and hemndialysis duration was 0.218 （P=0.018）. AR incidence in AECA positive recipients was 38.7%, greater than that in AECA negative recipients （23.4%, P=0.002）. Incidence of acute T cell-mediated rejection and acute antibody-mediated rejection increased significantly （P=0.035, P=0.002 respectively）. Muhifactor logistic regression analysis indicated that AECA positive, PRA greater than 10% and high CDC level were risk factors of AR with odds ratio of 2.056, 1.751 and 1.764 respectively （P=0.004, 0.029, 0.050）. Conclusions The AECA positive in pre-transplant serum indicates the elevated risk of acute allograft rejection. The AECA level increases with prolonged hemodialysis duration.