Predictive value of kidney injury markers for early DGF in kidney transplant recipients
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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。 -
关键词:
- 肾移植 /
- 急性肾小管坏死 /
- 缺血-再灌注损伤 /
- 肾损伤 /
- 移植物功能延迟恢复 /
- 中性粒细胞明胶酶相关脂质运载蛋白(NGAL) /
- 血清胱抑素C(Cys-C) /
- 血清肌酐(Scr)
Abstract:Objective To evaluate the predictive values of serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, serum cystatin C (Cys-C) and serum creatinine (Scr) for early delayed graft function (DGF) in kidney transplant recipients. Methods Clinical data, blood and urine samples of 159 kidney transplant recipients were collected. All recipients were divided into the DGF group (n=42) and immediate graft function (IGF) group (n=117) according to the incidence of DGF. Clinical data of all recipients were analyzed. The changes of serum NGAL, urine NGAL, Cys-C and Scr levels were statistically compared between two groups. The predictive values of different markers for early DGF were assessed. Results Among 159 kidney transplant recipients, DGF occurred in 42 cases with an incidence rate of 26.4%. There were statistically significant differences in donor age, cold ischemia time of donor kidney and complement-dependent cytoxicity (CDC) between the two groups(all P < 0.05). Within postoperative 2 weeks, the serum NGAL levels in the DGF group were higher than those in the IGF group (all P < 0.05). The Cys-C, Scr and urine NGAL levels in the DGF group were higher compared with those in the IGF group within 3 weeks after kidney transplantation(all P < 0.001). Serum NGAL, urine NGAL, Cys-C and Scr levels had certain predictive values for early DGF in kidney transplant recipients. Cys-C yielded the highest predictive value with a cut-off value of 4.73 mg/L, sensitivity of 0.833, specificity of 0.812 and area under the curve (AUC) of 0.895. Conclusions Cys-C has higher predictive value for early DGF in kidney transplant recipients compared with serum NGAL, urine NGAL and Scr. -
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值 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[M(P25, 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[M(P25, 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) 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 -
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