同种肾移植受者移植后早期尿六联蛋白动态检测的临床研究

The clinical evaluation of the six urinary proteins with dynamic test in the renal allograft recipients

目的：研究肾移植后3个月内尿六联蛋白动态变化与移植肾功能转归之间的关系及其临床意义。方法：对2004年10月-2005年3月间34例首次同种肾移植受者作了共计190例次尿六联蛋白动态检测，对其移植肾功能状态进行评价并作分析。结果：34例受者尿A1M和IGU浓度的变化与移植肾功能的变化显著相关（P〈0．05）。其中，又以IGU（β=64．737）对血清肌酐（SCr）的影响较A1M（β=5．160）大。移植肾功能恢复异常组尿六联蛋白的浓度，SCr浓度和环孢素（CsA）的使用剂量高于移植肾功能恢复正常组。移植肾功能恢复异常组中的A1M和IGU与SCr相关（P〈0．05〉；其中，又以IGU（β=122．175）对SCr的影响较A1M（β=5．034）为大。正常组中的A1M、MA和IGU与SCr相关，差异有统计学意义（P〈0．05〉；其中，对SCr影响最大的为IGU（β=16．147），然后依次为A1M（β=9．234）和MA（β=2．306）。移植肾发生排斥者的A1M、MA、TRU、IGU及RBP的浓度均高于移植肾发生肾毒性者；其中，又以MA的差别较为明显（约133．990），然后依次为TRU（59．90％）和IGU（51．21％）。而排斥亚组移植受者的NAG合计值比肾毒性亚组移植受者要低约13．700。A1M／SCr、MA／SCr和IGU／SCr的范围在移植肾发生排斥亚组和移植肾发生肾毒性亚组之间差异无统计学意义（P〉0．05）。结论：肾移植受者尿六联蛋白的动态监测，有助于肾脏移植后早期、无创伤性的对移植肾的功能变化进行评估，从而辅助、指导医师对临床治疗方案作出进一步的调整或修正。

Objective： （1） Investigate the difference of the urinary proteins expression between the Group A （normal renal graft function ） and Group B （abnormal renal graft function ） ; （2）Reveal the possible clinical significance of the urinary proteins expression in the recipients who received a cadaver renal transplantation. Methods：34 recipients who received a cadaver renal transplantation in Ruijin Hospital from October 2004 to March 2005 were dynamic tested total 190 urine samples and analysed according to the data of recipients. Results： A1M and IGU were related to SCr in the 34 recipients（ P 〈0.05）, especially the IGU. According to the comparison of Group A and Group B, we found the A1M.MA.TRU.IGU,NAG .RBP ,SCr and CsA were higher in Group B than in Group A （RBPwas 69.6% ,A1M 51.9%, TRU 29.2% ,NAG 28.5% and MA 24.7%）. But there were no statistic significance between the urinary proteins in Group A and them in Group B. There was statistic significance between the CsA in Grpup A and in Group B（ P 〈0.05）. A1M and IGU were related to SCr in Group B（ P 〈0.05）, especially the IGU（β=122. 175）. A1M.MA and IGU were related to SCr in Group A（ P 〈0.05）, especially the IGU（β =16. 147）and AIM（β=9. 234）. According to the comparison of Group B1 （acute rejection subgroup） and Group B2 （CsA nephrotoxicity subgroup）, we found the A1M.MA.TRU.IGU and RBP were higher in Group B1 than in Group B2, especially MA （133.99%） ,TRU （59.90%） and IGU（ 51. 21%）. The NAG in Group B1 was 13.70% lower than it in Group B2. The A1M/SCr,MA/SCr and IGU/SCr were no statistic significance between Group B1 and Group B2 （ P 〉0. 05）. Conclusions：The A1M.MA.TRU,IGU.NAG and RBP are convenient and safety monitoring markers for the clinical reference and evaluation.