腎移植后早期檢測尿轉(zhuǎn)化生長因子β的臨床意義

1、腎移植后早期檢測尿轉(zhuǎn)化生長因子的臨床意義         07-08-28 09:42:00     編輯：studa20        作者：王平賢，范明齊，賈維勝，馮嘉瑜，肖亞，方針強(qiáng)，黃赤兵，張艮甫 【關(guān)鍵詞】  腎移植    Clinical significance of urine TGF1 in predicting longterm renal all

2、ograft function【Abstract】 AIM: To determine the association between urine transforming growth factor 1（TGF1）concentration in early posttransplant time and longterm renal allograft function. METHODS:  Blood and urine TGF1 concentrations were tested in renal recipients who had had kidney transpla

3、ntation for one year and whose renal functions were normal from August 1, 1999 to April 30, 2001. One hundred and twentysix cases completed the 3year followup. Correlation between their renal functions (creatinine clearance rates, Ccr) and their urine TGF1 relative concentrations after 1 year of ren

4、al transplantation were determined. Losses of Ccr and numbers of renal dysfunction in groups with different urine TGF1 concentrations were compared. Of the 126 cases, 15 renal recipients were diagnosed as chronic allograft nephropathy (CAN). Their blood and urine TGF1 concentrations and other factor

5、s after 1 year of renal transplantation were compared with those of the normal renal recipients who had no CAN. RESULTS:  Urine TGF1 relative concentrations after 1 year of renal transplantation in the 126 patients mentioned above were 138.1-437.5 ng/g. There was a positive correlation between

6、the longterm renal functions (Ccr) and the urine TGF1 relative concentrations after 1 year of renal transplantation. The patients with higher urine TGF1 concentration 1 year after renal transplantation had more loss of Ccr in the next 3 years than those with lower urine TGF1 concentration. One year

7、after renal transplantation, the urine TGF1 concentrations of CAN and noCAN recipients were (184.4±38.7) and (399.0±37.5) ng/g respectively, with significant difference. The blood TGF1 concentrations of CAN and no CAN recipients were (33.3±5.4) and (32.7±5.1) g/L respectively, wi

8、th no significant difference. CONCLUSION:  TGF1 may play an important role in CAN. Urine TGF1 is significantly higher before renal dysfunction in patients with CAN. The level of urine TGF1 in early stage after renal transplantation can be used to predict the longterm renal function.【Keywords】 k

9、idney transplantation; nephropathy; TGF1【摘要】 目的：探討腎移植受者術(shù)后早期尿轉(zhuǎn)化生長因子1（TGF1）是否與遠(yuǎn)期移植腎功能有關(guān)聯(lián). 方法：199908/200104腎移植術(shù)后滿1 a、腎功能正常的患者檢測血、尿TGF1濃度，并對上述患者進(jìn)行3 a以上的前瞻性觀察，對觀察期內(nèi)腎功不全的患者明確是否為慢性移植腎腎?。–AN）. 3 a后共有126例患者完成了全程隨訪，將其腎功能與3 a前的尿TGF1濃度作相關(guān)性分析，判斷二者是否相關(guān)；比較術(shù)后1 a時(shí)尿TGF1不同濃度患者在3 a觀察期內(nèi)肌酐清除率（Ccr）損失量有無差異、CAN病例數(shù)有無差異；共有15例

10、診斷為CAN的患者，比較CAN患者與非CAN (nCAN)患者于腎移植1 a在血、尿TGF1等方面有無差異. 結(jié)果：術(shù)后1 a尿TGF1濃度為138.1437.5 ng/g；尿TGF1濃度與3 a后的Ccr之間有相關(guān)性（r=0.429, P<0.01）；尿TGF1濃度高的患者在3 a觀察期內(nèi)Ccr損失量明顯大于尿TGF1濃度低的患者；nCAN與CAN患者在腎移植1 a時(shí)，尿TGF1分別為(184.4±38.7)和(399.0±37.5) ng/g（P<0.01），血TGF1分別為(33.3±5.4)和(32.7±5.1) g/L（P>0

11、.05）. 結(jié)論：TGF1可能在CAN的發(fā)生過程中起重要作用，CAN患者在腎功能異常前尿TGF1已顯著升高，腎移植后早期檢測尿TGF1對遠(yuǎn)期腎功能具有預(yù)測作用.【關(guān)鍵詞】 腎移植；腎??；轉(zhuǎn)移生長因子0引言由于免疫抑制劑的發(fā)展和臨床移植水平的提高，腎移植近期效果已得到了顯著的改善. 然而，腎移植遠(yuǎn)期效果卻未能得以相應(yīng)的提高，慢性移植物腎?。╟hronic allograft nephropathy，CAN）導(dǎo)致腎功能進(jìn)行性減退，CAN呈現(xiàn)出以細(xì)胞外基質(zhì)沉積、間質(zhì)纖維化、腎小管萎縮為特點(diǎn)的各種非特異性的病理改變1. 轉(zhuǎn)化生長因子（transforming growth factor 1，TGF1）

12、過度表達(dá)引起組織纖維化2 是CAN的基本特點(diǎn)，故TGF1在CAN的發(fā)生過程中可能起重要作用. 我們探討腎移植患者術(shù)后血、尿TGF1濃度與遠(yuǎn)期移植腎功能的關(guān)系，為臨床早期診斷和防治CAN提供方法與依據(jù).1對象和方法1.1對象我院199908/200104術(shù)后滿1 a, 且移植腎功能正常的患者172例. 以雙抗夾心ELISA法檢測血、尿TGF1濃度, 根據(jù)尿肌酐（Cr）計(jì)算出尿TGF1的相對濃度=尿TGF1/尿Cr(ng/g). 人TGF1 ELISA試劑盒購自晶美生物工程（北京）有限公司. 進(jìn)行3 a以上的前瞻性觀察，觀察期內(nèi)每13 mo檢測1次腎功能，計(jì)算出肌酐清除率（Ccr）；對血Cr異常升

13、高（Cr114 mol/L）的患者，根據(jù)上述標(biāo)準(zhǔn)明確是否為CAN. 3 a后有126例患者完成了全程隨訪（CAN者則至明確診斷時(shí)為止）；其中15例診斷為CAN. 血清Cr114 mol/L在腎移植至少6 mo以后，以甲基強(qiáng)的松龍等激素沖擊治療和調(diào)整免疫抑制劑等處理后腎功呈進(jìn)行性減退. 移植腎穿剌根據(jù)“Banff 97”分類標(biāo)準(zhǔn)沒有急性排斥反應(yīng)、急性環(huán)孢素A中毒、腎小球腎炎復(fù)發(fā)等，而呈現(xiàn)以間質(zhì)纖維化、腎小管萎縮等為特點(diǎn)的各種非特異性病理改變.1.2方法分析126例患者術(shù)后1 a時(shí)尿TGF1與3 a后Ccr之間的相關(guān)性.  比較術(shù)后1 a時(shí)不同尿TGF1濃度的患者，在以后的3 a觀察期內(nèi)Ccr損失量和腎功不全病例數(shù)有無差異. 具體方法為：Ccr損失量=術(shù)后1 a時(shí)的Ccr-3 a后的Ccr（恢復(fù)透析者則為首次透析前的Ccr）；上述126例患者術(shù)后1 a時(shí)尿TGF1濃度為：138.1437.5 ng/g，將其分成基本等同的A，B，C 3個(gè)區(qū)段（Group）：138.1240.0，240.1340.0，340.1438.5 ng/g，比較不同區(qū)段患者的Ccr損失量和腎功不全病例數(shù)