肾移植早期尿TGF-β_1对慢性移植物肾病的影响

A Study on the Effects of Early Posttransplant Urine TGF-β_1 on Chronic Allograft Nephropathy

目的: 探讨早期检测肾移植患者尿转化生长因子β1 (TGF β1 )对远期慢性移植物肾病(CAN)有无预测作用。方法: 对144例肾移植时间达1年、肾功能正常的患者,检测尿TGF β1 浓度,然后将TGF β1 浓度最低和最高的各40例患者组建为组Ⅰ、组Ⅱ,对上述80例患者进行至少3年的前瞻性观察;比较2组在3年内肾功能的损失量和肾功能不良者的病例数有无差异;分析早期尿TGF β1 浓度与远期肾功能有无相关性;对肾功能不良者做移植肾穿剌活检,明确是否为CAN。结果: 组Ⅱ肌酐清除率(Ccr)进行性降低。3年后,组ⅡCcr损失量和肾功不良者的病例数分别为(14 4±10 3)ml/min和9例,显著大于组Ⅰ(P<0 01),后者分别为(6 8±5 7)ml/min和2例;术后达1年时的尿TGF β1 浓度与3年后的肾功能二者间有着显著的相关性(r=0 409,P<0 01);肾功能不良者,移植肾在组织学上均呈CAN的改变。结论: TGF β1 可能在CAN的发生中起着重要的作用,肾移植早期尿TGF β1 浓度对CNA具有预测作用,TGF β1 浓度高者远期肾功能差。

Objective: To determine whether urine TGF-β 1 concentration is predictive for chronic allograft nephropathy (CAN). Methods: Urine TGF-β 1 concentrations were tested for 144 recipients who had had renal transplantation for one year.Of them, 40 cases with lower urine TGF-β 1 concentrations formed groupⅠ, and other 40 cases with higher urine TGF-β 1 formed group Ⅱ.Three years later, renal function, blood and urine TGF-β 1 concentrations were compared between the two groups. The relation between urine TGF-β 1 and CAN was assessed. Biopsies were carried out in renal recipients whose creatinine was higher than normal. Results: 3 years later, group II had a loss of creatinine clearance (Ccr) of 14.4±10.3(ml/min) and 9 cases suffering from CAN. There was more loss of renal function and more number of CAN cases in group II than in group I (P<0.01). Urine TGF-β 1 concentration in group I grew more obviously. The differences in the two groups were significant. There was an association between urine TGF-β 1 and CAN(r=0.416, P<0.01). All biopsies showed the characters of CAN. Conclusions: The findings suggest that urine TGF-β 1 is significantly higher in patients with CAN. The level of urine TGF-β 1 in early stage after renal transplantation can predict future renal function.