摘要
目的:探讨心脏死亡器官捐献(DCD)肾移植术后患者血清金属蛋白酶组织抑制物-2(TIMP-2)和胰岛素样生长因子结合蛋白7(IGFBP7)对术后肾功能延迟恢复(DGF)的预测价值。方法:采用前瞻性研究设计,选取2018年1月至2020年10月宁波大学附属李惠利医院收治的DCD肾移植患者。纳入标准:①数据资料完整;②术后早期未发生影响移植肾功能的严重并发症。排除标准:①数据资料不完整;②患者不能或不愿配合研究;③术后早期发生影响移植肾功能的严重并发症。用ELASE法定量检测患者肾移植术后6、12、24、48、72 h以及术后7 d的血清TIMP-2和IGFBP7水平,监测同期及术后21 d血肌酐值。根据DGF的发生情况,分析不同时间点TIMP-2和IGFBP7测量值以及二者乘积(TIMP-2×IGFBP7)对肾移植术后发生DGF的预测能力。采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评价TIMP-2和IGFBP7对DGF的诊断效能。结果:共纳入33例患者,DGF组7例(21.2%),非DGF组26例(78.8%),两组的性别(男/女:3/4例与10/16例)、年龄[48(34~56)岁与45(23~61)岁]、供体肾小球滤过率[98.5(15.8~132.5)ml/(min·1.73m 2)与79.1(60.6~102.5)ml/(min·1.73m 2)]、术前肌酐[1114.0(731.4~1293.0)μmol/L与858.4(657.6~1051.9)μmol/L]、术前尿素氮[15.0(13.2~19.6)mmol/L与17.3(13.6~20.9)mmol/L]、术前白蛋白[43.5(38.5~45.3)mmol/L与41.2(37.5~46.1)mmol/L]、透析方式(血透/腹透:3/4例与9/17例)、术中热缺血时间[6(5~7)min与5(4~6)min]差异均无统计学意义(P>0.05)。DGF组血清IGFBP7、TIMP-2×IGFBP7值在各个时间点均高于非DGF组(F=15.753,P=0.040;F=13.000,P=0.024),而两组间血清TIMP-2差异无统计学意义(F=1.157,P=0.075)。对DGF的诊断价值,血清IGFBP7在术后48 h的AUC为0.863(95%CI 0.696~1.000,P=0.004),以5.97 ng/ml为界值时,敏感性为85.7%,特异性为80.8%;TIMP-2×IGFBP7在术后48 h的AUC为0.819(95%CI 0.641~0.996,P=0.011),以62.06(ng/ml)2为界值时,敏感性为71.4%,特异性为80.8%;两者的AUC比�
Objective This study is to investigate the predictive value of serum levels of TIMP-2 and insulin-like growth factor-binding protein 7(IGFBP7)in patients with DCD(donation after cardiac death)kidney transplantation.Methods A prospective research design was used to select DCD kidney transplant patients admitted to the Li Huili Hospital of Ningbo University from January 2018 to October 2020.Inclusion criteria:①Complete data;②There were no serious complications affecting the function of the transplanted kidney in the early postoperative period.Exclusion criteria:①Incomplete data;②Patients were unable or unwilling to cooperate with the study;③Severe complications affecting the function of the transplanted kidney occurred early after the operation.The ELASE method was used to quantitatively detect the serum TIMP-2 and IGFBP7 levels at 6,12,24,48,72 hours and 7 days after renal transplantation,and monitor the serum creatinine values during the same period and 21 days after the operation.According to the occurrence of DGF,the measured values of TIMP-2 and IGFBP7 at different time points and their product's ability to predict the occurrence of DGF after kidney transplantation were analyzed.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnostic efficacy of TIMP-2 and IGFBP7 for DGF.Results A total of 33 patients were enrolled,7 patients(21.2%)in the DGF group and 26 patients(78.8%)in the non-DGF group.Between the two groups,the donor glomerular filtration rate were[98.5(15.8-132.5)ml/(min·1.73m2)and 79.1(60.6-102.5)ml/(min·1.73m2)],recipient gender(male/female:3/4 cases and 10/16 cases),recipient age[48(34-56)Years old and 45(23-61)years old],the recipient's preoperative creatinine[1114.0(731.4-1293.0)μmol/L and 858.4(657.6-1051.9)μmol/L],the recipient's preoperative urea nitrogen[15.0(13.2-19.6)mmol/L and 17.3(13.6-20.9)mmol/L],receptor preoperative albumin[43.5(38.5-45.3)mmol/L and 41.2(37.5-46.1)mmol/L],recipient dialysis method[hemodialysis/perit
作者
崔晓波
沈洲姬
诸医蒙
王依娜
仉超
张孝认
李如兵
郑巳年
Cui Xiaobo;Shen Zhouji;Zhu Yimeng;Wang Yina;Zhang Chao;Zhang Xiaoren;Li Rubing;Zheng Sinian(Department of Urology,Ningbo Medical Center Lihuili Hospital,Ningbo University,Ningbo 315040,China;Department of Nephrology,Ningbo Medical Center Lihuili Hospital,Ningbo University,Ningbo 315040,China;Clinical Laboratory,Ningbo Medical Center Lihuili Hospital,Ningbo University,Ningbo 315040,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第8期620-626,共7页
Chinese Journal of Urology
基金
宁波市自然科学基金项目(2018A610302)。
关键词
肾移植
金属蛋白酶组织抑制物-2
胰岛素样生长因子结合蛋白7
肾功能延迟恢复
Kidney transplantation
Tissue inhibitor of metalloproteinase-2(TIMP-2)
Insulin-like growth factor-binding protein 7(IGFBP7)
Delayed graft function(DGF)
