中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
2期
112-115
,共4页
蒋一航%王玮%胡小鹏%尹航%刘航%任亮%王伟%范博涵%张小东
蔣一航%王瑋%鬍小鵬%尹航%劉航%任亮%王偉%範博涵%張小東
장일항%왕위%호소붕%윤항%류항%임량%왕위%범박함%장소동
肾移植%肾机能不全%移植肾功能延迟恢复%中性粒细胞明胶酶相关载脂蛋白%胱抑素c
腎移植%腎機能不全%移植腎功能延遲恢複%中性粒細胞明膠酶相關載脂蛋白%胱抑素c
신이식%신궤능불전%이식신공능연지회복%중성립세포명효매상관재지단백%광억소c
Kidney transplantation%Renal insufficiency%Delayed graft function%Neutrophil gelatinase-associated lipocalin%Cystatin c
目的 探讨中性粒细胞明胶酶相关载脂蛋白(NGAL)和胱抑素c(Cys c)对于移植肾功能恢复的诊断效能.方法 选取2012年10月至2013年10月进行尸体供肾同种异体肾移植术的114例受者,将术后1周需要血液透析的受者归为移植肾功能延迟恢复(DGF)组,无需血液透析的受者归为移植肾功能早期恢复(EGF)组.测定两组受者术前及术后4、12、24、72和168 h血清NGAL(sNGAL)、血清Cys c(sCys c)和血清肌酐(sCr)浓度,以及术后4、12、24 h尿液NGAL(uNGAL)浓度.通过受试者工作特征(ROC)曲线评价不同标志物的诊断效能.结果 114例肾移植受者中,DGF组23例,EGF组91例.EGF组内sNGAL和sCys c术后4h内环比下降率大于sCr[51.31％ (40.30％,62.31％)、56.39％(50.02％,68.40％)比21.40％ (6.77％,27.44％),P =0.009、0.029].EGF和DGF组间比较时,sNGAL和sCys c环比下降率出现差异的时间早于uNGAL和sCr,可更敏感地预测DGF.sCr早期诊断效能高于uNGAL,但低于sNGAL、sCys c.sNGAL、sCys c两种标志物在移植术后12 h诊断DGF的ROC曲线下面积达到峰值(0.975、0.958).sNGAL和Cys c联合应用后,ROC曲线下面积可达1.000.结论 sNGAL和sCys c可预测肾移植术后移植物恢复情况,将二者联合应用,将显著提高DGF诊断的特异性和敏感性.
目的 探討中性粒細胞明膠酶相關載脂蛋白(NGAL)和胱抑素c(Cys c)對于移植腎功能恢複的診斷效能.方法 選取2012年10月至2013年10月進行尸體供腎同種異體腎移植術的114例受者,將術後1週需要血液透析的受者歸為移植腎功能延遲恢複(DGF)組,無需血液透析的受者歸為移植腎功能早期恢複(EGF)組.測定兩組受者術前及術後4、12、24、72和168 h血清NGAL(sNGAL)、血清Cys c(sCys c)和血清肌酐(sCr)濃度,以及術後4、12、24 h尿液NGAL(uNGAL)濃度.通過受試者工作特徵(ROC)麯線評價不同標誌物的診斷效能.結果 114例腎移植受者中,DGF組23例,EGF組91例.EGF組內sNGAL和sCys c術後4h內環比下降率大于sCr[51.31％ (40.30％,62.31％)、56.39％(50.02％,68.40％)比21.40％ (6.77％,27.44％),P =0.009、0.029].EGF和DGF組間比較時,sNGAL和sCys c環比下降率齣現差異的時間早于uNGAL和sCr,可更敏感地預測DGF.sCr早期診斷效能高于uNGAL,但低于sNGAL、sCys c.sNGAL、sCys c兩種標誌物在移植術後12 h診斷DGF的ROC麯線下麵積達到峰值(0.975、0.958).sNGAL和Cys c聯閤應用後,ROC麯線下麵積可達1.000.結論 sNGAL和sCys c可預測腎移植術後移植物恢複情況,將二者聯閤應用,將顯著提高DGF診斷的特異性和敏感性.
목적 탐토중성립세포명효매상관재지단백(NGAL)화광억소c(Cys c)대우이식신공능회복적진단효능.방법 선취2012년10월지2013년10월진행시체공신동충이체신이식술적114례수자,장술후1주수요혈액투석적수자귀위이식신공능연지회복(DGF)조,무수혈액투석적수자귀위이식신공능조기회복(EGF)조.측정량조수자술전급술후4、12、24、72화168 h혈청NGAL(sNGAL)、혈청Cys c(sCys c)화혈청기항(sCr)농도,이급술후4、12、24 h뇨액NGAL(uNGAL)농도.통과수시자공작특정(ROC)곡선평개불동표지물적진단효능.결과 114례신이식수자중,DGF조23례,EGF조91례.EGF조내sNGAL화sCys c술후4h내배비하강솔대우sCr[51.31％ (40.30％,62.31％)、56.39％(50.02％,68.40％)비21.40％ (6.77％,27.44％),P =0.009、0.029].EGF화DGF조간비교시,sNGAL화sCys c배비하강솔출현차이적시간조우uNGAL화sCr,가경민감지예측DGF.sCr조기진단효능고우uNGAL,단저우sNGAL、sCys c.sNGAL、sCys c량충표지물재이식술후12 h진단DGF적ROC곡선하면적체도봉치(0.975、0.958).sNGAL화Cys c연합응용후,ROC곡선하면적가체1.000.결론 sNGAL화sCys c가예측신이식술후이식물회복정황,장이자연합응용,장현저제고DGF진단적특이성화민감성.
Objective To assess the diagnostic values of novel biomarkers,such as neutrophil gelatinase-associated lipocalin (NGAL) and cystatin c (Cys c),in the diagnosis of delayed graft function (DGF).Methods A total of 114 patients undergoing kidney transplantation from deceased donors from October 2012 to October 2013 were enrolled.Recipients on dialysis during the first postoperative week were included into DGF group while those without DGF into early graft function (EGF) group.sNGAL,sCys c and serum creatinine (sCr) were measured pre-operation,as well as at 4,12,24,72 and 168 h postoperation.Furthermore,uNGAL leveks were measured at 4,12 and 24 h post-transplantation.The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of DGF.Results Among 114 recipients enrolled,23 presented DGF and 91 EGF.In EGF group,within 4 h post-transplantation sNGAL and sCys c decreased more significantly than sCr (51.31％ (40.30％,62.31％),56.39％(50.02％,68.40％) vs 21.40％(6.77％,27.44％),P=0.009 and 0.029 respectively).Between two groups,differences of sequential decrease were observed earlier in sNGAL and sCys c than uNGAL and sCr.It demonstrated better performance in predicting DGF.The AUC of sCr was between uNGAL and sNGAL,sCys c.Combination of both sNGAL and sCys c yielded a ROC-AUC of 1.000.Conclusions sNGAL and sCys are ideal for predicting the recovery of graft function during early period after kidney transplantation.And a combination of both biomarkers may dramatically improve the specificity and sensitivity of diagnosing DGF.
