尿CXCL9/SCr及CXCL10/SCr对肾移植排斥反应的诊断价值  

Diagnostic values of urinary levels of CXCL9/SCr and CXCL10/SCr in kidney transplant rejection recipients based upon Luminex technology

作　　者：许洋 李琳[1] 曹玉 陈杰 詹盼盼 赵杰[1] Xu Yang;Li Lin;Cao Yu;Chen Jie;Zhan Panpan;Zhao Jie(Department of kidney transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肾移植科,天津300192

出　　处：《中华器官移植杂志》2024年第4期259-264,共6页Chinese Journal of Organ Transplantation

基　　金：天津市科技计划项目(21JCYBJC01010);天津市卫生健康委员会科技项目(ZC20227)。

摘　　要：目的探讨肾移植受者尿CXCL9/SCr与CXCL10/SCr对排斥反应的诊断价值。方法收集2021年3月至2022年7月于天津市第一中心医院肾移植科行移植肾穿刺活检的120例受者临床数据,根据病理结果分为排斥反应组(72例)、BK病毒肾病(BKVN)组(16例)及移植肾病组(32例),并以肾功能稳定组(20例)为对照,比较各组之间一般情况及尿CXCL9/SCr、CXCL10/SCr差异,进一步根据排斥反应的类型,将排斥反应组72例受者分为T细胞介导的排斥反应组(≥1A TCMR组,28例)、抗体介导的排斥反应组(AMR组,32例)和交界性TCMR组(10例),对排斥反应组进行亚组分析,明确不同排斥类型间差异,采用受试者操作特征曲线(receiver operator characteristic curve,ROC curve)评价尿CXCL9/SCr与CXCL10/SCr特异度及敏感度,并对其进行相关性分析。结果四组受者一般资料差异无统计学意义,排斥反应组与BKVN组比较,尿CXCL9/SCr与CXCL10/SCr的差异无统计学意义(均P>0.05),排斥反应组和BKVN组此两组值均大于移植肾病组及肾功能稳定组(均P<0.01),移植肾病组与肾功能稳定组相比无统计学意义(P>0.05);对排斥反应亚组分析中,≥1A TCMR组中尿CXCL9/SCr与CXCL10/SCr值均分别大于交界性TCMR组及AMR组(均P<0.01),交界性TCMR组与AMR组相比,差异无统计学意义(均P>0.05);尿CXCL9/SCr对监测排斥反应的曲线下面积(area under the curve,AUC)为0.938,阈值为0.482µg/mol,尿CXCL10/SCr AUC为0.89,阈值为5.516µg/mol,且尿CXCL9/SCr与CXCL10/SCr存在高度线性相关性。结论尿CXCL9/SCr及CXCL10/SCr可作为移植肾排斥反应敏感和特异性的早期、无创标志物,有望成为新的移植肾排斥反应的诊断工具,但仍需与BKVN进行区别。ObjectiveTo explore the diagnostic values of urinary levels of CXCL9/SCr and CXCL10/SCr in kidney transplant rejection patients.MethodFrom March 2021 to July 2022,the relevant clinical data were retrospectively reviewed for 120 recipients undergoing kidney transplant biopsy at Tianjin First Central Hospital.According to the results of pathological examinations,they were assigned into three groups of rejection(72 cases),BK virus nephropathy(BKVN,16 cases)and transplant nephropathy(32 cases).Renal function stable group(20 cases)was selected as control group.And 72 recipients in rejection group were divided into three sub-groups of≥1A T cell mediated rejection(TCMR,28 cases),antibody-mediated rejection(AMR,32 cases)and borderline TCMR(10 cases).Subgroup analysis of rejection group was performed for clarifying the differences among various rejection types.The specificity and sensitivity of urinary CXCL9/SCr and CXCL10/SCr were evaluated by receiver operator characteristic(ROC)curve and their correlations examined.ResultNo significant difference existed in general profiles among four groups.No difference existed between urinary CXCL9/SCr and CXCL10/SCr between rejection and BKVN groups.And the values of these two groups were higher than those of transplant nephropathy and renal function stable groups(P<0.01).In subgroup analysis of rejection,urinary CXCL9/SCr and CXCL10/SCr values in rejection group were higher than those in borderline TCMR and AMR groups(P<0.01).No difference existed between borderline TCMR and AMR groups.Urinary CXCL9/SCr had an AUC of 0.938 and a threshold of 0.482µg/mol while urinary CXCL10/SCr had an AUC of 0.89n and a threshold of 5.516µg/mol.Urinary CXCL9/SCr and CXCL10/SCr had a high linear correlation.ConclusionUrinary CXCL9/SCr and CXCL10/SCr may be employed as early non-invasive detection markers for RT rejection sensitivity and specificity.

关 键 词：肾移植 排斥反应 生物标志物 

分 类 号：R699.2[医药卫生—泌尿科学]