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肾损伤标志物对肾移植受者发生DGF的早期预测价值

李峰 浦金贤 黄玉华 席启林 潘浩 赵晓俊 胡林昆

李峰, 浦金贤, 黄玉华, 等. 肾损伤标志物对肾移植受者发生DGF的早期预测价值[J]. 器官移植, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
引用本文: 李峰, 浦金贤, 黄玉华, 等. 肾损伤标志物对肾移植受者发生DGF的早期预测价值[J]. 器官移植, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
Li Feng, Pu Jinxian, Huang Yuhua, et al. Predictive value of kidney injury markers for early DGF in kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012
Citation: Li Feng, Pu Jinxian, Huang Yuhua, et al. Predictive value of kidney injury markers for early DGF in kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2022, 13(1): 74-79. doi: 10.3969/j.issn.1674-7445.2022.01.012

肾损伤标志物对肾移植受者发生DGF的早期预测价值

doi: 10.3969/j.issn.1674-7445.2022.01.012
基金项目: 

江苏省重点研发计划面上项目 BE2020654

详细信息
    作者简介:

    李峰,男,1987年生,博士,主治医师,研究方向为泌尿外科,Email:lifengdaxia2001@163.com

    通讯作者:

    胡林昆,男,1983年生,博士,副主任医师,研究方向为泌尿外科,Email: hulinkunsz@163.com

  • 中图分类号: R617, R692

Predictive value of kidney injury markers for early DGF in kidney transplant recipients

More Information
  • 摘要:   目的  探讨血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿NGAL、血清胱抑素C(Cys-C)以及血清肌酐(Scr)预测肾移植受者发生肾功能延迟恢复(DGF)的价值。  方法  收集159肾移植受者的临床资料及血液、尿液标本,根据是否发生DGF,分为DGF组(42例)和即刻肾功能恢复(IGF)组(117例)。分析两组受者的临床资料,对比两组受者的血NGAL、尿NGAL、Cys-C及Scr变化情况,分析不同指标对DGF的早期预测价值。  结果  159例肾移植受者中,42例发生DGF,发生率为26.4%。两组供者年龄、供肾冷缺血时间及补体依赖淋巴细胞毒性试验(CDC)比较,差异有统计学意义(均为P < 0.05)。DGF组血NGAL在术后2周内均高于IGF组(均为P < 0.05);DGF组Cys-C、Scr、尿NGAL在术后3周内均高于IGF组(均为P < 0.001)。血NGAL、尿NGAL、Cys-C和Scr对肾移植受者发生DGF具有一定预测价值,其中Cys-C预测价值最高,截取值为4.73 mg/L,灵敏度为0.833,特异度为0.812,曲线下面积(AUC)为0.895。  结论  Cys-C早期预测肾移植受者发生DGF的价值高于血NGAL、尿NGAL及Scr。

     

  • 图  1  两组肾损伤标志物的变化趋势

    注:与IGF组比较,aP < 0.05。

    Figure  1.  Change trends of kidney injury markers in two groups

    图  2  肾损伤标志物预测DGF的ROC曲线

    Figure  2.  ROC curves of kidney injury markers in predicting DGF

    表  1  两组受者一般资料比较

    Table  1.   Comparison of general data of recipients between the two groups

    变量 DGF组(n=42) IGF组(n=117) P
    受者资料
      年龄(x±s,岁) 44±10 42±10 0.169
      性别[n(%)] 0.853
        男 26(62) 75(64)
        女 16(38) 42(36)
      BMI(x±s,kg/m2 23±4 22±3 0.267
      原发病[n(%)] 0.951
        慢性肾小球肾炎 7(17) 25(21)
        IgA肾病 5(12) 14(12)
        局灶硬化肾小球肾炎 1(2) 4(3)
        多囊肾 1(2) 5(4)
        高血压肾病 5(12) 10(9)
        糖尿病肾病 3(7) 5(4)
        其他 20(48) 54(46)
      血型[n(%)] 0.211
        A型 10(24) 34(29)
        B型 10(24) 41(35)
        AB型 5(12) 14(12)
        O型 17(40) 28(24)
      透析类型[n(%)] 0.084
        腹膜透析 9(21) 39(33)
        血液透析 32(76) 71(61)
        其他 1(2) 7(6)
      透析时间[MP25, P75),月] 36(18, 75) 24(9, 60) 0.055
      移植前Scr(x±s,μmol/L) 939±249 957±300 0.732
    供者资料
      年龄(x±s,岁) 44±10 39±9 0.007
      捐献前Scr[MP25, P75),μmol/L] 112(67, 171) 91(75, 115) 0.096
      供肾冷缺血时间(x±s,h) 15±5 12±4 0.001
    配型情况
      CDC(x±s,%) 2.9±0.9 2.5±0.6 0.015
      HLA错配数(x±s,个) 4.3±0.8 4.1±1.0 0.428
      PRA阴性[n(%)] 42(100) 117(100) 1.000
    免疫诱导方案[n(%)] 1.000
      ATG 19(45) 52(44)
      巴利昔单抗 23(55) 65(56)
    免疫抑制方案[n(%)] 0.798
      他克莫司 37(88) 100(86)
      环孢素 5(12) 17(14)
    下载: 导出CSV

    表  2  肾损伤标志物预测DGF的价值

    Table  2.   Efficacy of kidney injury markers in predicting DGF

    指标 截取值 灵敏度 特异度 阳性预测值 阴性预测值
    血NGAL 658.7 ng/mL 0.786 0.598 0.413 0.886
    尿NGAL 837.6 ng/mL 0.738 0.803 0.574 0.895
    Cys-C 4.73 mg/L 0.833 0.812 0.614 0.931
    Scr 693 μmol/L 0.905 0.496 0.392 0.935
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-09-03
  • 网络出版日期:  2022-01-12
  • 刊出日期:  2022-01-15

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