中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (31): 5705-5708.doi: 10.3969/j.issn.1673-8225.2010.31.002

• 肾移植 kidney transplantation • 上一篇    下一篇

早期移植肾功能异常预警：尿中性粒细胞明胶酶相关脂笼蛋白和白细胞介素18有价值吗？

霍文谦，靳凤烁，聂志林，李黔生，朱方强，张克勤   

  1. 解放军第三军医大学大坪医院野战外科研究所泌尿外科，重庆市   400042
  • 出版日期:2010-07-30 发布日期:2010-07-30
  • 通讯作者: 张克勤，博士，副教授，解放军第三军医大学大坪医院野战外科研究所泌尿外科，重庆市 400042 zhkq2000@sina.com
  • 作者简介:霍文谦★，男，1976年生，湖北省襄樊市人，汉族，1998年解放军第三军医大学毕业，硕士，主治医师，主要从事肾移植临床及研究工作。 huowenqian@yahoo.com.cn
  • 基金资助:

    解放军第三军医大学临床科研基金资助(2008XG182)。

Urinary neutrophil gelatinase-associated lipocalin and interleukin-18 in the predictive diagnosis of early graft disfunction following renal transplantation

Huo Wen-qian, Jin Feng-shuo, Nie Zhi-lin, Li Qian-sheng, Zhu Fang-qiang, Zhang Ke-qin   

  1. Department of Urinary Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing   400042, China
  • Online:2010-07-30 Published:2010-07-30
  • Contact: Zhang Ke-qin, Doctor, Associate professor, Department of Urinary Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing 400042, China zhkq2000@sina.com
  • About author:Huo Wen-qian★, Master, Attending physician, Department of Urinary Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA, Chongqing 400042, China huowenqian@yahoo.com.cn
  • Supported by:

    the Clinical Scientific Research Foundation of the Third Military Medical University of Chinese PLA, No. 2008XG182*

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摘要：

背景：移植肾功能延迟恢复是肾移植后常见的并发症，其预警诊断和病因诊断对指导早期干预治疗有重要价值，中性粒细胞明胶酶相关脂笼蛋白、白细胞介素18已被证实是一种诊断急性肾小管损伤的标志物，但其在早期移植肾功能异常的预测及病因诊断的意义方面尚未见报道。
目的：评价尿中性粒细胞明胶酶相关脂笼蛋白(neutrophil gelatinase-associated lipocalin，NGAL)和白细胞介素18水平在早期移植肾功能异常预警诊断和病因诊断的价值。
方法：应用ELISA方法检测71例患者肾移植后的第1个24 h尿NGAL和白细胞介素18水平。根据移植后肾功能恢复情况分为肾功能迅速恢复组(n=41)和早期肾功能异常组(n=30)，将早期肾功能异常组按病因分为急性肾小管坏死组(n=18)和急性排斥反应组(n=12)，按肾功能恢复形式分为缓慢恢复组(n=16)和延迟恢复组(n=14)，观察尿液NGAL和白细胞介素18水平与肾功能恢复的关系。
结果与结论：所有患者移植后尿NGAL和白细胞介素8均明显升高，但早期肾功能异常组明显高于迅速恢复组。急性排斥反应导致的肾功能异常组白细胞介素18明显高于急性肾小管坏死导致的肾功能异常组(P < 0.01)，两组尿NGAL水平差异无显著性意义(P > 0.05)。缓慢恢复组尿NGAL水平较延迟恢复组高(P < 0.01)，两组尿白细胞介素18水平差异无显著性意义(P > 0.05)。提示尿NGAL和白细胞介素18可作为预测早期移植肾功能异常的标志物，白细胞介素18有助于急性排斥反应病因诊断，而NGAL的升高除了诊断移植肾功能异常外，还可能成为预测肾功能恢复能力的指标。

关键词: 白细胞介素18, NGAL, 延迟恢复, 诊断, 肾移植

Abstract:

BACKGROUND: Delayed renal graft function is a common complication of renal transplantation. Therefore, the predication etiological diagnosis is important for early treatment. Urinary neutrophil gelatinase-associated lipocalin (NGAL) and interleukin (IL)-18 have been proved to be specific and susceptible markers for the diagnosis of acute renal tubule injury. However, the role of NGAL and IL-18 in the prediction or etiological diagnosis of early graft disfunction following renal transplantation remains uncertain.  
OBJECTIVE: To investigate the value of the urinary NGAL and IL-18 for the prediction or etiological diagnosis of early graft disfunction in renal transplantation.
METHODS: The urinary NGAL and IL-18 of the first 24 hours in 71 patients following renal transplantation were detected by enzyme linked immunosorbent assay (ELISA). The patients were divided into 2 groups including 41 cases of immediate graft function and 30 cases of graft disfunction. The graft disfunction group were subdivided into acute tubular necrosis (ATN, n=18) and acute rejection (AR, n=12) according to the origin of graft disfunction, and they were divided into slow graft function (SGF, n=16) and delayed graft function (DGF, n=14) according to the type of graft function. The clinical significance was evaluated by analyzing the correlation of urinary NGAL or IL-18 and the recovery of graft function.
RESULTS AND CONCLUSION: The urinary NGAL or IL-18 of all patients were significantly increased following renal transplantation, but the graft disfunction group was significantly greater than the immediate graft function group. For cases of graft disfunction, the level of IL-18 in AR group was significantly greater than ATN group (P < 0.01), but the level of NGAL was of no significant difference between the two groups (P > 0.05). However the level of NGAL of SGF group was significantly greater than the DGF group (P < 0.01), and the level of IL-18 was similar in the two groups (P > 0.05). Results show that urinary NGAL and IL-18 are useful for predicting the early graft function after renal transplantation. Moreover, high urinary IL-18 can help to the diagnosis of AR and high NGAL may suggest the recovery capability of graft function.

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