中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2008年
5期
310-313
,共4页
曾章新%陈娟%邓章郴%谭建明%王庆华%吴卫真%杨顺良
曾章新%陳娟%鄧章郴%譚建明%王慶華%吳衛真%楊順良
증장신%진연%산장침%담건명%왕경화%오위진%양순량
半胱氨酸蛋白酶抑制剂%肾移植%肌酐%肌酐清除率
半胱氨痠蛋白酶抑製劑%腎移植%肌酐%肌酐清除率
반광안산단백매억제제%신이식%기항%기항청제솔
Cystatin C%Kidney transplantation%Creatinine%Creatinine clearance
目的 探讨肾移植术后患者血清半胱氨酸蛋白酶抑制物(CyC)的水平变化与移植肾功能的相关性.方法选择193例使用他克莫司(FK506)加霉酚酸酯(MMF)加泼尼松(Pred)三联免疫抑制剂肾移植患者术后的血、尿标本,测定血清CyC和血、尿肌酐.经统计学分析,与常规的血清肌酐(SCr)浓度及尿肌酐清除率(CCr)和内生肌酐清除率(CkCCr)作相关性比较,评估CyC判断移植肾肾小球滤过功能的敏感性和特异性.结果 193例肾移植患者术后第5天血清CyC、SCr和CCr、CkCCr分别为(1.91±1.28)mg/L、(174.2±129.1)μmol/L、(67.9±27.3)ml/min、(68.1±27.8)ml/min.其中CyC浓度＜1.25 mg/L者42例,1.25～2.00 mg/L者102例,＞2.0 mg/L者49例;SCr浓度＜125/μmol/L者62例,125～200μmol/L者83例,＞200/μmol/L者48例;CkCCr＞80ml/min者52例,80～60 ml/min者96例,＜60 ml/min者45例.CyC与SCr呈正相关(r=0.886,P＜0.001),与CkCCr呈负相关(r=-0.907,P＜0.001);SCr与CkCCr呈负相关(r=-0.889,P＜0.001).非参数受试者工作特征曲线分析CyC、SCr、CCr、CkCCr曲线下面积分别为0.877、0.771、0.832、0.909,其诊断敏感性和特异性分别为91.6%、69.3%,52.2%、96.1%,67.5%、77.1%和84.6%、71.3%. 结论 肾功能轻度损害时,血清CyC比SCr先一步增高,有可能成为评定肾移植患者移植肾功能的敏感性标志物.
目的 探討腎移植術後患者血清半胱氨痠蛋白酶抑製物(CyC)的水平變化與移植腎功能的相關性.方法選擇193例使用他剋莫司(FK506)加黴酚痠酯(MMF)加潑尼鬆(Pred)三聯免疫抑製劑腎移植患者術後的血、尿標本,測定血清CyC和血、尿肌酐.經統計學分析,與常規的血清肌酐(SCr)濃度及尿肌酐清除率(CCr)和內生肌酐清除率(CkCCr)作相關性比較,評估CyC判斷移植腎腎小毬濾過功能的敏感性和特異性.結果 193例腎移植患者術後第5天血清CyC、SCr和CCr、CkCCr分彆為(1.91±1.28)mg/L、(174.2±129.1)μmol/L、(67.9±27.3)ml/min、(68.1±27.8)ml/min.其中CyC濃度＜1.25 mg/L者42例,1.25～2.00 mg/L者102例,＞2.0 mg/L者49例;SCr濃度＜125/μmol/L者62例,125～200μmol/L者83例,＞200/μmol/L者48例;CkCCr＞80ml/min者52例,80～60 ml/min者96例,＜60 ml/min者45例.CyC與SCr呈正相關(r=0.886,P＜0.001),與CkCCr呈負相關(r=-0.907,P＜0.001);SCr與CkCCr呈負相關(r=-0.889,P＜0.001).非參數受試者工作特徵麯線分析CyC、SCr、CCr、CkCCr麯線下麵積分彆為0.877、0.771、0.832、0.909,其診斷敏感性和特異性分彆為91.6%、69.3%,52.2%、96.1%,67.5%、77.1%和84.6%、71.3%. 結論 腎功能輕度損害時,血清CyC比SCr先一步增高,有可能成為評定腎移植患者移植腎功能的敏感性標誌物.
목적 탐토신이식술후환자혈청반광안산단백매억제물(CyC)적수평변화여이식신공능적상관성.방법선택193례사용타극막사(FK506)가매분산지(MMF)가발니송(Pred)삼련면역억제제신이식환자술후적혈、뇨표본,측정혈청CyC화혈、뇨기항.경통계학분석,여상규적혈청기항(SCr)농도급뇨기항청제솔(CCr)화내생기항청제솔(CkCCr)작상관성비교,평고CyC판단이식신신소구려과공능적민감성화특이성.결과 193례신이식환자술후제5천혈청CyC、SCr화CCr、CkCCr분별위(1.91±1.28)mg/L、(174.2±129.1)μmol/L、(67.9±27.3)ml/min、(68.1±27.8)ml/min.기중CyC농도＜1.25 mg/L자42례,1.25～2.00 mg/L자102례,＞2.0 mg/L자49례;SCr농도＜125/μmol/L자62례,125～200μmol/L자83례,＞200/μmol/L자48례;CkCCr＞80ml/min자52례,80～60 ml/min자96례,＜60 ml/min자45례.CyC여SCr정정상관(r=0.886,P＜0.001),여CkCCr정부상관(r=-0.907,P＜0.001);SCr여CkCCr정부상관(r=-0.889,P＜0.001).비삼수수시자공작특정곡선분석CyC、SCr、CCr、CkCCr곡선하면적분별위0.877、0.771、0.832、0.909,기진단민감성화특이성분별위91.6%、69.3%,52.2%、96.1%,67.5%、77.1%화84.6%、71.3%. 결론 신공능경도손해시,혈청CyC비SCr선일보증고,유가능성위평정신이식환자이식신공능적민감성표지물.
Objective To study the correlation between the post-transplant renal allograft function and the variation of serum cystatin C (CyC) concentration in renal allograft recipients. Methods One hundred and ninety-three renal allograft recipients accepted the same combination immunosuppressive regimen of tacrolimus, mycophenolate and prednisone were enrolled into the study. Patient's serum and urine samples were collected on day 5 post-transplant to detect serum cystatin C, serum and urine creatinine (SCr). Correlation analysis was used to analyze correlation between CyC concentration and SCr concentration or the calculated creatinine clearance rate (CkCCr) by using the Cockcroft-Gault equation and urine creatinine clearance rate (CCr). Specificity and sensitivity of using the CyC concentration to evaluate glomerular filtration rate (GFR) were calculated as well.Results The mean concentrations of serum CyC and SCr on day 5 post-transplant were (1.91±1.2)mg/L and (174.0±129.1)μmol/L, respectively. While the CCr and CkCCr were (67.9±27.3)ml/min and (68.1±27.8)ml/min, respectively. Forty-two patients had a CyC concentration below 1.25 mg/L, 102 patients'CyC concentrations were between 1.25 and 2.0 mg/L and 49 patients'CyC concentrations were above 2. 0 mg/L. As for SCr, 62 patients had a concentration below 125 μmol/L, 83 patients'concentrations were between 125 and 200 μmol/L and 48 patients'concentrations were above 200 μmol/L. For CkCCr, there were 52 cases with a concentration above 80 ml/min, 96 cases with a concentration between 80 and 60 ml/min and 45 cases with a concentration below 60 ml/min. Serum CyC concentration had a negative correlation with CkCCr (r=-0. 907, P＜0. 001) and had a significantly positive correlation with SCr concentration (r=0. 886, P＜0. 001). SCr had a significantly negative relationship with CkCCr (r=-0. 889 ,P＜0. 001). Serum CyC had higher correlation with CkCCr than the correlation between SCr and CkCCr. The ROC curves showed that areas under curve of CyC, SCr, CCr and CkCCr were 0. 877, 0. 771, 0. 832 and 0. 909, respectively. Specificity and sensitivity of CyC, SCr,CCr and CkCCr were 69.3%, 96.1%, 77.1%, 71.3%and 91.6%, 52.2%, 67.5%, 84.6%, respectively.Conclusions Serum CyC concentration elevates earlier than SCr concentration when there is slight renal function impairment. Serum CyC concentration might become a more sensitive marker to evaluate the post-transplant renal allograft function in renal transplant recipients.
