肾移植术后尿TGF-β1与移植肾功能关系的临床研究

Predictive effects of TGF-beta1 on long-term renal allograft function after transplantation

目的 探讨肾移植受者早期尿转化生长因子beta1(TGF beta1)与远期肾功能的关系。方法 1999年8月至2 0 0 1年6月期间对肾移植术后满1年、肾功能正常的患者检测血、尿TGF beta1浓度,并对上述患者进行3年以上的前瞻性观察,对观察期内肾功不全的患者,活检明确是否为慢性移植肾肾病(CAN)。共有13 4例患者完成了全程随访,其中有16例诊断为CAN的患者,比较CAN患者与非CAN患者在肾移植1年时的血、尿TGF beta1等有无差异;分析术后1年时尿TGF beta1浓度与远期肾功能的关系。结果 上述13 4例患者,术后1年时尿TGF beta1浓度为:(13 5 6～44 2 3 )pg mg·Cr ,其中,尿TGF beta1浓度高的患者,在3年观察期内Ccr减损量明显大于尿TGF beta1浓度低的患者(P <0 0 1) ;CAN患者在肾移植1年时,尿TGF beta1浓度(3 98±3 3 5 )pg mg·Cr明显高于非CAN患者(182 7±40 2 )pg mg·Cr(P <0 0 1) ;非CAN与CAN患者,血TGF beta1浓度分别为(3 2 1±4 7)和(3 1 9±4 8)ng ml,两者比较差异不显著(P >0 0 5 )。结论 TGF beta1可能在CAN的发生过程中起着重要的作用,CAN患者在肾功能异常前尿TGF beta1已显著升高,肾移植后早期检测尿TGF beta1对远期肾功能具有预测作用。

Objective To determine the association between urine transforming growth factor beta1 (TGF-beta1) concentration and long-term renal allograft function. Methods From August 1, 1999 to June 30, 2001, renal recipients who had performed kidney transplantation for one year with normal renal functions were investigated. The blood and urine TGF-beta1 concentrations were tested in an interval of at least 6 months. Three years later, a total of 134 cases had been followed up for the whole investigation. Correlation between the renal functions (creatinine clearance rates) and the urine TGF-beta1 relative concentrations after 1 year of renal transplantation were determined. Out of the 134 cases, 16 renal recipients were diagnosed as chronic allograft nephropathy (CAN), whose blood and urine TGF-beta1 concentrations and other factors were compared with those of the normal renal recipients who had no CAN. Results There were a positive correlation between long-term renal functions (loss of creatinine clearance rates) and urine TGF-beta1 relative concentrations after 1 year of renal transplantation. One year after renal transplantation, the urine TGF-beta1 concentrations of CAN and non-CAN recipients were 182.7±40.2 and 398±33.5 pg/mg respectively (P<0.01). The blood TGF-beta1 concentrations of CAN and non-CAN recipients were 32.1±4.7 and 31.9±4.8 ng/ml respectively (P>0.05). Conclusion The findings suggest that urine TGF-beta1 is significantly higher before renal dysfunction in patients with CAN. The level of urine TGF-beta1 in early stage after renal transplantation can be a predictor of long-term renal functions.