摘要
目的:
1.找到一种用于肾移植后肾功能检测的新指标,初步应用于肾移植后移植物功能的检测,并探讨其水平与移植肾功能(肾小球滤过率)的关系。
2.通过对术后半胱氨酸蛋白酶抑制剂C、血清肌酐(sCr)、尿素氮(BUN)各项指标的比较,探讨半胱氨酸蛋白酶抑制剂C作为早期肾功能损伤评估指标的应用价值。
方法:
采用回顾性分析方法,70例肾移植患者术后一月内动态监测血清肌酐、半胱氨酸蛋白酶抑制剂C,并用Modification of Diet in Renal Disease equation(MDRD公式)计算内生肌酐清除率。研究对象分为肾功能正常组(A组,31例,GFR≥90ml/min/1.73m~2)、轻度受损组(60≤GFR<90ml/min/m~2)组和肾功能中重度受损组(D组,4例,GFR<60ml/min/m~2).依据血清肌酐正常与否,肾功能轻度受损组又分为肌酐正常组(B组,23例,Scr≤133μmol/L)和肌酐异常组(C组,12例,Scr>133μmol/L)。并与正常对照组(60例)相比较。分别绘制各组Cys C和SCr与CCr关系的散点图,并求出相关系数r。采用免疫增强散射比浊法测定半胱氨酸蛋白酶抑制剂C的水平,以流式细胞术连续检测CD4/CD8比值,ELISA检测免疫抑制剂药物浓度,评估机体的免疫状态。血生化仪测定血肌酐、尿素氮。
结果:
1.健康正常对照人群半胱氨酸蛋白酶抑制剂C的浓度是(0.72±0.13)mg/L。血清肌酐浓度为(50.48±15.20)μmol/L。
2.各组移植前半胱氨酸蛋白酶抑制剂C、血清肌酐、和尿素氮水平无显著差异(P>0.05)。
3 A组半胱氨酸蛋白酶抑制剂C浓度为(0.96±0.10)mg/L.B组半胱氨酸蛋白酶抑制剂C浓度为(1.37±0.14)mg/L.与A组对照比较有统计学差异(P<0.05)。
4.A组血清肌酐浓度为(90.51±9.86)μmol/L.B组血清肌酐浓度为(105.27±13.76)μmol/L.与A组对照比较无统计学差异(P>0.05)
5.GFR在A、B、C组与SCr、Cys C均呈直线相关,其中r分别为-0.7272和-0.7439,-0.7072和-0.7543,-0.7430和-0.7669。
结论:
Cys C浓度在肾移植术后肾功能损伤早期检测中具有重要价值。在肌酐虽然正常但CCr已经降低的患者中,其浓度已有显著变化,Cys C与肌酐清除率在肾功能正常和轻度受损患者中均呈直线相关性,其相关系数与血肌酐相比,甚至优于血清肌酐。Cystatin C单项诊断肾功能损伤时变化更明显,性能优于其他指标。由于其不受体内分解代谢,饮食等因素干扰,所以可以应用于临床,作为肾移植术后肾功能检测的常规检测指标。外周血Cystatin C检测作为一个评估移植肾功能的指标具有无创性,结果显示Cystatin C具有很高的临床应用价值,可以简便、省时、准确的应用于大量的移植患者术后移植物功能的监测。
Objects
1 To find a new index to detect the renal function after renal transplantation. This index was used in detecting the graft function. Meanwhile we rearch the relationship between Cystatin C and GFR (glomerular filtration rate).
2Through compared with Scr and BUN, to show the vulue of Cystatin C as an index in detecting the graft function after renal transplantation. And the value of cystatin C (Cys C) in the early detection of the graft function damagement after renal transplantation and providing evidence for the further diagnosis and treatment.
Methodology
At the twelfth day post-transplantation, monitored the concentration ofCys C, blood urea nitrogen (BUN) , Serum creatinine (SCr) and the glomerular filtration rate (GFR). GFR was determined by the Modification of Diet in Renal Disease equation (MDRD equation). According to the value of GFR post-transplantation, 70 cases of renal transplant patients were divided into group A (31 cases, with the normal renal function, GFR=90ml/min/1.73m~2), group B (Scr=133μmol/L, 60=GFR<90ml/min/1.73m~2, 27 cases), group C (Scr > 133μmol/L, 60=GFR<90ml/min/1.73m~2,12 cases) and group D (GFR < 60ml/min/1.73m~2, 4 cases). Meanwhile, the normal control group (n = 60) was compared. Analysis the linear correlation between Cys C, Scr and GFR through the scatterplots in each groups, and calculated the correlation coefficient(r). Determination of Cys C was performed using the Behring BN II Pro Spec analyzer. Meanwhile, used the automatic biochemistry analyzer and correlated kits to analysis the serum creatinine concentration.
Results
1. Cys C concentration in normal control group was 0.72±0.13 mg/L. Scr concentration was 50.48±15.20μmol/L.
2. The concentration of Scr, Cystatin C and BUN had no conspicuous statistically significance (P>0.05), compared with the normal control pre-transplantation.
3. Cys C concentration in group B (27 cases) were (1.37±0.14), the difference has conspicuous statistically significance (P<0.01), compared with that of group A (0.96±0.10) mg/L.
4.Scr concentration in group B (27 cases) were (105.26±13.76)μmol/L, the difference has no statistically significance (P>0.05), compared with that of group A (90.51±9.86)μmol/L.
5.Through the scatterplot, SCr and Cys C showed similar linear correlation with GFR in group A, B and C. The correlation coefficient (r) of each group was -0.7272 and -0.7439, -0.7072 and -0.7543, -0.7430 and -0.7669.
Conclusion
Cys C concentration was not influenced by diet, infection. Compared with the Scr, Cys C has the similar relevance with GFR even better when the graft function was normal and lightly renal function damaged. After transplantation, when the grafts function was damaged slightly, the Cys C had a more sensitive changement, espiacially when the Scr concentration had not increased. This indicated that the Cys C had a more sensitively and intimate correlation with GFR. Cys C, as a rapid, sensitive index, could be used in the early diagnosis of renal function damage after renal transplantation.
Significance
Our study is useful for renal transplantation in order to enhance long-term survival. It can diagnose early damagement of the draft function and help doctors to adjust the dose of immunosuppressant.
引文
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