供肾灌洗液生物标志物预测移植肾功能延迟恢复的临床研究  

Prediction by biomarker of cardiac death organ donation renal lavage fluid of delayed renal function recovery in kidney transplan recipients

作　　者：杨青彦[1] 索敬钧 刘君毅[1] YANG Qingyan;SUO Jingjun;LIU Junyi(Department of Renal Transplant,Zhengzhou Seventh People's Hospital,Zhengzhou 450016,China)

机构地区：[1]郑州市第七人民医院肾移植科,郑州450016

出　　处：《肾脏病与透析肾移植杂志》2023年第3期238-242,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：河南省医学科技攻关联合共建项目(2018020859)。

摘　　要：目的:研究心脏死亡器官捐献(DCD)供肾灌洗液生物标志物与移植肾功能延迟恢复(DGF)的相关性,探讨其预测DGF的价值。方法:选取2019年3月至2020年5月郑州市第七人民医院的142例肾移植受者,根据其在移植术后是否出现DGF分为DGF组(n=18)和移植肾功能即刻恢复(IGF)组(n=124)。比较两组供肾灌洗液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素18(IL-18)、肝型脂肪酸结合蛋白(L-FABP)、肾损伤分子1(KIM-1)等生物标志物的浓度,并分析其与DGF发生的相关性。结果:DGF组供肾灌洗液NGAL浓度明显高于IGF组(P<0.05),其他标志物两组间无统计学差异。DGF组术后第1天、第2天、第3天、第7天的血清肌酐(SCr)值均高于IGF组(P<0.05)。受试者工作特征(ROC)曲线显示,供肾灌洗液联合NGAL和KIM-1预测DGF时,诊断价值最高(AUC=0.931,P<0.001,敏感度100%,特异度73.8%)。进一步联合供肾灌洗液NGAL+KIM-1+术后第3天SCr值时,准确性更高(AUC=0.974,P<0.001,敏感度100%,特异度为86.3%)。结论:供肾灌洗液NGAL与肾移植受者发生DGF呈正相关。采用NGAL+KIM-1+术后第3天SCr值预测DGF的发生诊断价值高,可为供肾质量的评估和后续治疗提供指导。Objective:To investigate the correlation between biomarkers in renal lavage fluid from cardiac death organ donation(DCD)donors and delayed renal graft function(DGF)after kidney transplantation,and to explore its predictive value for the occurrence of DGF.Methodology:142 kidney transplant patients admitted to our hospital were selected as the research subjects,and were divided into the DGF group(n=18)and the immediate recovery of transplanted kidney function(IGF)group(n=124)based on whether they experienced DGF after transplantation.Compare the concentrations of biomarkers such as lipid transport protein(NGAL),interleukin-18(IL-18),liver type fatty acid binding protein(L-FABP),and kidney injury molecule-1(KIM-1)in two groups of renal lavage fluid,and analyze their correlation with the occurrence of DGF.Results:The concentrations of IL-18,KIM-1,and L-FABP in the DGF group showed relatively small differences compared to the IGF group(P>0.05);The NGAL concentration in the DGF group was significantly higher than that in the IGF group,with a significant difference(P<0.05).The blood creatinine levels in the DGF group were significantly higher than those in the IGF group on the 1st,2nd,3rd,and 7th day after surgery(P<0.05).The receiver operating characteristic(ROC)curve showed that when the Biomarker NGAL and KIM-1 jointly predicted DGF,the diagnostic value was the highest(AUC=0.931,P<0.001,sensitivity=100%,specificity=73.8%).Further analysis found that when NGAL+KIM-1+was used to detect the blood creatinine value on the 3rd day after surgery,the accuracy was high,the sensitivity could reach 100%,the AUC could reach 0974,the specificity was 86.3%,and P<0.001.Conclusion:The biomarker NGAL in donor renal lavage fluid is positively correlated with delayed recovery of renal function in kidney transplant patients.The diagnostic value of using NGAL+KIM-1+blood creatinine value on the 3rd day after surgery to predict the occurrence of delayed recovery of renal function is high,which can provide guidance for the evaluation of

关 键 词：心脏死亡器官捐献 供肾灌洗液生物标志物 移植肾功能延迟恢复 

分 类 号：R699.2[医药卫生—泌尿科学]