供者TIMP-2和IGFBP7对移植术后受者肾功能延迟的预测价值  

Predictive values of donor TIMP-2 and IGFBP7 in delayed graft function after kidney transplantation

作　　者：仉超 沈洲姬 诸医蒙 王依娜 崔晓波 张孝认 徐鹏杰[1] 裘晓蕙[1] Zhang Chao;Shen Zhouji;Zhu Yimeng;Wang Yina;Cui Xiaobo;Zhang Xiaoren;Xu Pengjie;Qiu Xiaohui(Department of Nephrology,Affiliated Lihuili Hospital,Ningbo Medical Center,Ningbo University,Ningbo 315040,China;Department of Urology,Affiliated Lihuili Hospital,Ningbo Medical Center,Ningbo University,Ningbo 315040,China;Department of Clinical Laboratory Medicine,Affiliated Lihuili Hospital,Ningbo Medical Center,Ningbo University,Ningbo 315040,China)

机构地区：[1]宁波大学附属李惠利医院肾内科,315040 [2]宁波大学附属李惠利医院泌尿外科,315040 [3]宁波大学附属李惠利医院检验科,315040

出　　处：《中华器官移植杂志》2021年第10期593-598,共6页Chinese Journal of Organ Transplantation

基　　金：宁波市自然科学基金项目(2018A610302)。

摘　　要：目的探讨供者血清和移植肾灌洗液中金属蛋白酶组织抑制物-2(TIMP-2)和胰岛素样生长因子结合蛋白7(IGFBP7)水平对心脏死亡供者供肾移植术后移植物功能延迟(DGF)的发生是否有预测价值。方法收集宁波市医疗中心李惠利医院2018年1月至2020年10月心脏死亡的肾移植供者33例以及对应的受者33例,留取供者术前血清和移植肾灌洗液标本,测定TIMP-2和IGFBP7的水平。根据肾移植术后是否发生DGF分为DGF组7例和非DGF组26例,将测定的指标进行分析。正态分布计量资料组间比较采用独立样本t检验,正态分布计数资料组间比较采用χ^(2)检验,非正态分布计量资料组间比较采用Mann-Whitney检验(秩和检验),应用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价指标的诊断效能。结果DGF组的灌洗液TIMP-2、灌洗液TIMP-2与IGFBP7的乘积(TIMP-2×IGFBP7)、血清IGFBP7、血清TIMP-2与IGFBP7的乘积(TIMP-2×IGFBP7)均高于非DGF组(P值均<0.05)。灌洗液TIMP-2、灌洗液TIMP-2×IGFBP7、血清IGFBP7、血清TIMP-2×IGFBP7诊断DGF的AUC分别为0.753(95%CI 0.546~0.959)、0.747(95%CI 0.510~0.984)、0.824(95%CI 0.615~1.000)、0.852(95%CI 0.660~1.000)。结论供者血清IGFBP7、供者血清TIMP-2×IGFBP7、灌洗液TIMP-2、灌洗液TIMP-2×IGFBP7可用于预测肾移植术后早期DGF的发生,其中血清TIMP-2×IGFBP7的诊断效能较高,是肾移植术后DGF的良好预测指标。Objective To explore the predictive values of tissue inhibitor of metalloproteinase-2(TIMP-2)and insulin-like growth factor binding protein 7(IGFBP7)in donor sera and lavage fluid on delayed graft function(DGF)in donation after circulatory death(DCD)kidney transplant recipients.Methods A total of 33 eligible kidney donors and 33 corresponding recipients were recruited.Preoperative serum and renal perfusion fluid samples of donors were collected to determine the levels of TIMP-2 and IGFBP7.Patients were grouped according to whether DGF occurred after kidney transplantation and measured indicators analyzed.Independent sample t test was utilized for comparing the groups with normal distribution measurement data.And χ^(2) test was employed for comparing the groups with normal distribution counting data and Mann-Whitney test for comparing the groups with non-normal distribution measurement data.Receiver operating characteristic(ROC)curve and area under curve(AUC)were used for evaluating the diagnostic efficacy of indicators.Results In donor-DGF group,lavage fluid TIMP-2,product of lavage fluid TIMP-2 and IGFBP7(TIMP-2×IGFBP7),serum IGFBP7 and product of serum TIMP-2 and IGFBP7(TIMP-2×IGFBP7)were higher than those in donor-non-DGF group(P<0.05).The AUC of TIMP-2,TIMP-2×IGFBP7,serum IGFBP7 and serum TIMP-2×IGFBP7 in the diagnosis of DGF were 0.753(95%CI 0.546~0.959),0.747(95%CI 0.510~0.984),0.824(95%CI 0.615~1.000)and 0.852(95%CI 0.660~1.000)respectively.Conclusions Donor serum IGFBP7,donor serum TIMP-2×IGFBP7,lavage fluid TIMP-2 and lavage fluid TIMP-2×IGFBP7 may be used for predicting the occurrence of early DGF after kidney transplantation.Among them,serum TIMP-2×IGFBP7 has the highest diagnostic efficiency and may be an excellent predictor of DGF occurrence.

关 键 词：肾移植 肾功能延迟 金属蛋白酶组织抑制物 

分 类 号：R699.2[医药卫生—泌尿科学]