肾移植受者早期血清25-羟基维生素D水平对急性排斥反应的预测价值研究  

Study on the Predictive Value of Serum 25-Hydroxyvitamin D Level in Early Renal Transplantation for Acute Rejection

作　　者：王坤英 张蓬杰[5] 王剑茹 陈好雨 游瑞君 梁娇霞 WANG Kunying;ZHANG Pengjie;WANG Jianru;CHEN Haoyu;YOU Ruijun;LIANG Jiaoxia(Nephropathy Laboratory,the Second People’s Hospital of Shanxi Province,Taiyuan 030012,China;Department of Medical Education,the Second People’s Hospital of Shanxi Province,Taiyuan 030012,China;Department of Kidney Transplantation Center,the Second People’s Hospital of Shanxi Province,Taiyuan 030012,China;Shanxi Acupuncture Hospital Outpatient Office,Taiyuan 030006,China;Nephropathy Hemodialysis Center,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]山西省第二人民医院肾病实验室,太原030012 [2]山西省第二人民医院医教科,太原030012 [3]山西省第二人民医院肾移植中心,太原030012 [4]山西省针灸医院门诊办,太原030006 [5]陕西省人民医院肾病血透中心,西安710068

出　　处：《现代检验医学杂志》2024年第4期138-142,共5页Journal of Modern Laboratory Medicine

基　　金：山西省卫生健康委“四个一批”科技兴医创新计划重点攻关专项(2023XM027)。

摘　　要：目的探讨血清25-羟基维生素D[25-hydroxy vitamin D,25(OH)D]水平对肾移植急性排斥反应(acute rejection,AR)的预测价值。方法选取2019年1月~2022年8月山西省第二人民医院同种异体肾移植受者324例。收集受者临床资料,分别采用化学发光免疫法和比色法检测移植术后早期(1月内)血清25(OH)D,甲状旁腺素(parathyroid hormone,PTH)和钙、磷水平,记录检测季节,观察移植术后一年内是否发生AR。定义25(OH)D水平≥20ng/ml为正常,≥12ng/ml~<20ng/ml为不足和<12ng/ml为缺乏,并分为25(OH)D正常组(n=106)、不足组(n=112)和缺乏组(n=106)。按照是否发生AR分为AR组(n=51)和非AR组(n=273)。分析血清25(OH)D水平基本情况,比较25(OH)D三组血清PTH,钙、磷水平和季节以及AR发生率的差异,多因素Logistic回归分析AR发生的影响因素,受试者工作特征(receiver operating characteristic,ROC)曲线分析血清25(OH)D水平对AR的预测价值。结果血清25(OH)D缺乏或不足发生率为67.28%(218/324)。25(OH)正常组、不足组和缺乏组血清PTH水平分别为75.44(46.42,113.23)pg/ml,78.29(58.27,152.10)pg/ml和86.84(54.64,127.3)pg/ml,AR发生率分别为2.47%(8/324),6.17%(20/324)和7.10%(23/324),均为缺乏组最高,正常组最低,差异具有统计学意义(H==6.784,χ^(2)=8.580,均P<0.05)。25(OH)D缺乏(OR=3.340,95%CI:1.409~7.916),25(OH)D不足(OR=2.442,95%CI:1.006~5.925)和人类白细胞抗原(human leucocyte antigen,HLA)错配(4~6个)(OR=2.117,95%CI:1.027~4.363)是AR发生的独立危险因素(均P<0.05)。血清25(OH)D水平预测AR的曲线下面积(area under curve,AUC)为0.702(95%CI:0.625~0.779),最佳截断值为13.59ng/ml,特异度和灵敏度分别为66.7%,65.6%。结论25(OH)D缺乏(<12ng/ml)或不足(≥12ng/ml~<20ng/ml)是肾移植患者发生AR的独立危险因素,血清25(OH)D水平对AR有一定预测价值。Objective To investigate the predictive value of serum 25-hydroxyvitamin D[25(OH)D]level in early renal transplantation for acute rejection(AR).Methods A total of 324 renal transplant recipients from January 2019 to August 2022 in the Second People’s Hospital of Shanxi Province were selected.The clinical data of the recipients were collected.The levels of serum 25(OH)D,parathyroid hormone(PTH),and calcium,phosphorus in early(within 1 month)transplantation were detected by chemiluminescence immunoassay and colorimetry,respectively.The detection season was recorded,and the occurrence of AR within 1 year after renal transplantation was observed.The 25(OH)D level≥20ng/ml was defined as normal,≥12 ng/ml~<20 ng/ml as insufficient and<12ng/ml as deficient,they were divided into of 25(OH)D normal group(n=106),insufficient group(n=112)and deficient group(n=106).According to the occurrence of AR,they were divided into AR group(n=51)and non-AR group(n=273).The basic situation of serum 25(OH)D level was analyzed.The differences in serum PTH,calcium,phosphorus levels and seasons as well as AR incidence among the three groups of 25(OH)D were compared.Multivariate logistic regression was used to analyze the influencing factors of AR,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum 25(OH)D level for AR.Results The incidence of serum 25(OH)D deficiency or insufficiency was 67.28%(218/324).In the 25(OH)D normal group,insufficient group and deficiency group,the serum PTH levels were 75.44(46.42,113.23)pg/ml,78.29(58.27,152.10)pg/ml and 86.84(54.64,127.3)pg/ml,and the incidences of AR were 2.47%(8/324),6.17%(20/324)and 7.10%(23/324),respectively.All of them were the highest in the deficiency group and the lowest in the normal group,and the differences were significant(H=6.784,χ^(2)=8.580,all P<0.05).Additionally,25(OH)D deficiency(OR=3.340,95%CI:1.409~7.916),25(OH)D insufficiency(OR=2.442,95%CI:1.006~5.925)and human leucocyte antigen(HLA)mismatch(4~6)(OR=2.117,95%CI:1.027~4.363

关 键 词：肾移植 25-羟基维生素D 急性排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学] R446.112[医药卫生—外科学]