肾移植后早期检测尿转化生长因子β的临床意义

Clinical significance of urine TGF-β_1 in predicting long-term renal allograft function

目的:探讨肾移植受者术后早期尿转化生长因子β1(TGF-β1)是否与远期移植肾功能有关联. 方法:1999-08/2001-04肾移植术后满1 a、肾功能正常的患者检测血、尿TGF-β1浓度,并对上述患者进行3 a以上的前瞻性观察,对观察期内肾功不全的患者明确是否为慢性移植肾肾病(CAN). 3 a后共有126例患者完成了全程随访,将其肾功能与3 a前的尿TGF-β1浓度作相关性分析,判断二者是否相关;比较术后1 a时尿TGF-β1不同浓度患者在3 a观察期内肌酐清除率(Ccr)损失量有无差异、CAN病例数有无差异;共有15例诊断为CAN的患者,比较CAN患者与非CAN (n-CAN)患者于肾移植1 a在血、尿TGF-β1等方面有无差异. 结果:术后1 a尿TGF-β1浓度为138.1～437.5 ng/g;尿TGF-β1浓度与3 a后的Ccr之间有相关性(r=0.429, P<0.01);尿TGF-β1浓度高的患者在3 a观察期内Ccr损失量明显大于尿TGF-β1浓度低的患者;n-CAN与CAN患者在肾移植1 a时,尿TGF-β1分别为(184.4±38.7)和(399.0±37.5) ng/g(P<0.01),血TGF-β1分别为(33.3±5.4)和(32.7±5.1) μg/L(P>0.05). 结论:TGF-β1可能在CAN的发生过程中起重要作用,CAN患者在肾功能异常前尿TGF-β1已显著升高,肾移植后早期检测尿TGF-β1对远期肾功能具有预测作用.

AIM： To determine the association between urine transforming growth factor β1（TGF-β1） concentration in early posttransplant time and long-term renal allograft function. METHODS： Blood and urine TGF-β1 concentrations were tested in renal recipients who had had kidney transplantation for one year and whose renal functions were normal from August 1, 1999 to April 30, 2001. One hundred and twenty-six cases completed the 3-year follow-up. Correlation between their renal functions （ creatinine clearance rates, Ccr） and their urine TGF-β1 relative concentrations after 1 year of renal transplantation were determined. Losses of Ccr and numbers of renal dysfunction in groups with different urine TGF-β1 concentrations were compared. Of the 126 cases, 15 renal recipients were diagnosed as chronic allograft nephropathy （CAN）. Their blood and urine TGF-β1 concentrations and other factors after 1 year of renal transplantation were compared with those of the normal renal recipients who had no CAN. RESULTS： Urine TGF-β1 relative concentrations after 1 year of renal transplantation in the 126 patients mentioned above were 138.1 -437.5 ng/g. There was a positive correlation between the long-term renal functions （Ccr） and the urine TGF-β1 relative concentrations after 1 year of renal transplantation. The patients with higher urine TGF-β1 concentration 1 year after renal transplantation had more loss of Ccr in the next 3 years than those with lower urine TGF-β1 concentration. One year after renal transplantation, the urine TGF-β1 concentrations of CAN and no-CAN recipients were （ 184. 4 ± 38. 7） and （399.0 ± 37.5 ） ng/g respectively, with significant difference. The blood TGF-β1 concentrations of CAN and noCAN recipients were （ 33.3 ±5.4 ） and （ 32. 3 ± 5. 4 ） iJg/L respectively, with no significant difference. CONCLUSION： TGF-β1 may play an important role in CAN. Urine TGF-β1 is significantly higher before renal dysfunction in patients with CAN. The level of urine TGF-β1 in early stage after renal transplantation can be used to predict the long-term renal function.