肾移植受者手术前后脂蛋白(a)的变化及其与急性排异的关系

The change of lipoprotein (a) in patient with renal transplantation before and after operation and the relationship with acute rejection

目的观察肾移植受者脂蛋白(a)[Lp(a)]在手术前后的变化以及与急性排斥反应(AR)的发生和肾功能恢复的关系。方法对43例接受同种异体肾移植术患者Lp(a)进行连续监测。结果患者移植前Lp(a)和三酰甘油(TG)显著高于对照组(P<0.01、P<0.05);载脂蛋白A1(ApoA1)显著低于对照组(P<0.01)。术后随时间延长,患者的Lp(a)呈持续性下降趋势,2周降至与对照差异无显著性。但不同组间差异明显。排斥组术前、术后Lp(a)均高于稳定组(P<0.05、P<0.01);而中毒组与稳定组差异无显著性(P>0.05)。在术前Lp(a)≥300mg/L的高Lp(a)患者中有55.6%术后发生AR,明显高于正常Lp(a)水平的患者,差异具有非常显著性(χ2=8.246,P<0.01)。结论肾移植患者术后Lp(a)明显降低,Lp(a)水平与AR之间存在着一定的关联,动态监测肾移植受者手术前后Lp(a)的变化对AR的发生具有提示作用。

Objective To investigate the change of lipoprotein (a) [Lp(a)] level before and after operation and the relationship of Lp(a) level with acute rejection (AR), and renal function recovery in renal transplantation patients. Methods The level of serum Lp(a) in 43 patients with renal transplantation was determined. Results The levels of (Lp(a)) and triglyceride(TG) increased in pre-graft group than those in control group (P<0.01, P<0.05); Apolipoprotein A1 (ApoA1) decreased in pre-graft group than those in control group (P<0.01). In post-graft group, the level of Lp(a) decreased and had no significant difference than that of control group at 2 weeks after transplantation. In AR group the levels of (Lp(a)) in pre- or post-graft were all elevated than those of remission group(P<0. 05, P<(0.01)). But the Lp(a) level was not significantly different between the toxic group and remission group (P>0.05). (55.6%) patients who had the (Lp(a))≥300 mg/L in pre-graft would have the AR in post-graft, so there was significant difference between the patients with Lp(a)≥300 mg/L and those with Lp(a)<300 mg/L(χ~2=8.246, P<0.01). Conclusions Lp(a) level is related to the acute rejection. Dynamic investigation on Lp(a) in pre- and post-graft may be useful for predicting the acute rejection.