摘要
目的分析和探讨供者血液中新型生物标物与移植肾功能恢复延迟(DGF)的关系,及其预测DGF的应用价值。方法选取2016年8月至2017年12月进行肾移植术的受者进行观察和评估,收集获取供者器官前12 h内的血液,使用酶联免疫吸附测定法(ELISA)检测供者血中性粒细胞明胶酶相关载脂蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)、肾脏损伤因子-1(KIM-1)、白细胞介素18(IL-18)等4个新型标志物。将受者按照是否发生DGF分为DGF组和早期移植肾功能恢复(EGF)组,分别计算两组供者4种新生物标志物的差异,并绘制受试者工作特征曲线(ROC曲线),寻找最佳诊断阳性界值,计算供者血液新型标志物预测DGF的灵敏度和特异度。结果70例受者,术后发生DGF(DGF组)8例,DGF总体发生率为11.43%。DGF组供者血NGAL浓度为(521.01±132.84)ng/ml,EG F组为(299.99±100.03)ng/ml(P<0.001),当NGAL浓度>425.15 ng/ml时,其预测DGF的敏感度为87.5%,特异性为90.3%,曲线下面积(AUC)为0.891。DGF组供者血IL-18浓度为(14.10±12.36)ng/ml,EGF组为(4.61±1.83)ng/ml(P=0.0475),当IL-18浓度>5.345 ng/ml时,其预测DGF的敏感度为1»0%,特异性为64.5%,AUC为0.914。两组供者间血L-FABP、血KIM-1均无明显差异。而供者血肌酐诊断DGF的敏感度为62.5%,特异性为75.8%,AUC为0.692。结论供者血NGAL和IL-18浓度的升高用于预测肾移植术后DGF优于供者血肌酐水平,具有良好的敏感性和特异性。
Objective To explore the relationship between new biomarkers in donor blood and delayed graft function after kidney transplantation and evaluate the clinical value of new biomarkers in the diagnosis of DGF(delayed graft function).Methods For recipients of donor kidney transplantation from August 2016 to December 2017,blood samples were collected from operations of donor organ resection within 12 hours of the day.Enzyme-linked immunosorbent assay(ELISA)was employed for detecting neutrophil gelatinase-associated lipocalin(NGAL),L-type fatty acid binding protein(L-FABP),kidney injury molecule-1(KIM-1)and interleukin-18(IL-18).They were divided into DGF and EGF(early graft function)groups according to the diagnosis of DGF.The inter-group differences of four new biomarkers were calculated.Receiver operating characteristic curve(ROC curve)was plotted for finding the best positive cutoff value and the sensitivity and specificity of new donor blood marker for diagnosing delayed graft function were calculated.Results Among them,8 had postoperative DGF and 62 had none.The overall incidence of DGF was 11.43%.The serum concentration of NGAL was 521.01±132.84 ng/ml in DGF group versus(299.99±100.03)ng/ml in EGF group(P<0.001).The ROC curve was plotted.With a NGAL concentration>425.15 ng/ml,the sensitivity and specificity for diagnosing DGF were 87.5%and 90.3%respectively.The area under the curve(AUC)was 0.891.The serum concentration of IL-18 was(14.10±12.36)ng/ml in DGF group and(4.61±1.83)ng/ml in EGF group(P=0.047).With a IL-18 concentration of>5.345 ng/ml,the sensitivity and specificity for diagnosing DGF were 100%and 64.5%respectively.The AUC was 0.914.No significant inter-group difference existed in serum L-FABP/KIM-1.The sensitivity of donor creatinine in the diagnosis of DGF was 62.5%,specificity 75.8%and AUC 0.692.Conclusions With an excellent level of sensitivity and specificity,an elevated concentration of NGAL/IL-18 in donor blood is superior to traditional creatinine in the diagnosis of DGF after renal transpl
作者
蔡继飞
王玮
任亮
孙泽家
李馨
郑翔
苏路路
张小东
Cai Jifei;Wang Wei;Ren Liang;Sun Zejia;Li Xin;Zheng Xiang;Su Lulu;Zhang Xiaodong(Urology Institute,Capital Medical University,Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华器官移植杂志》
CAS
北大核心
2020年第2期94-98,共5页
Chinese Journal of Organ Transplantation
基金
首都临床特色应用研究专项(Z171100001017055)。
