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目的:初步评价高危角膜移植术前供者与受者进行HLA配型的临床意义。方法:将角膜新生血管≥2个象限或结膜上皮化的角膜、药物治疗无效的全角膜溃疡列为高危角膜,44例(44跟)。一步单抗法检测Ⅰ类抗原,DNA法检测HLA-Ⅱ类抗原。根据HDA位点的相配数分为4组:HLA的2错配、3错配、4错配、5错配。结果:术后排斥反应发生率为79.5%(35/44),2错配组为9.1%(4/44),3错配组为11.3%(5/44),4错配组为27.3%(12/44),5错配组为31.8%(14/44),其中4错配和5错配的排斥反应率高达59.1%(26/44),而2错配和3错配排斥反应率则为20.4% (9/44),高错配组的排斥反应率远高于低错配组。结论:对高危角膜患者,HLA高错配组的排斥反应率高于低错配组,术前进行组织相容性抗原HLA配型有临床指导意义。
Objective: To evaluate the clinical significance of HLA matching between donor and recipient before high-risk corneal transplantation. Methods: corneal neovascularization ≥2 quadrants or conjunctival epithelial cornea, drug-ineffective corneal ulcer were classified as high-risk cornea, 44 cases (44 with). One-step monoclonal antibody detection of antigen Ⅰ, DNA detection of HLA-Ⅱ antigen. According to HDA loci matching number is divided into 4 groups: HLA 2 mismatch, 3 mismatch, 4 mismatch, 5 mismatch. Results: The incidence of postoperative rejection was 79.5% (35/44), 9.1% (4/44) in the 2 mismatch group, 11.3% (5/44) in the 3 mismatch group and 27.3% in the 4 mismatch group (12/44) in the 5 mismatch group and 31.8% (14/44) in the 5 mismatch group, with rejection rates of 4 mismatch and 5 mismatch being as high as 59.1% (26/44), while mismatch 2 and 3 mismatch rejection The rate was 20.4% (9/44). The rejection rate in the high-mismatched group was much higher than that in the low-mismatched group. CONCLUSIONS: In high-risk corneal patients, the rejection rate of HLA-mismatched patients is higher than that of patients with low-mismatched mismatches. It is of clinical significance to preoperative HLA matching of histocompatibility antigens.