肾小管泌氢功能检测在肾移植对抗排斥反应治疗效果中的应用(英文)

Utilization of examining hydrogen ion excretion of renal tubule in antirejection therapy following renal transplantation

背景:移植后的急性排斥是肾移植术后的主要并发症,也是导致慢性排斥反应和移植物失功最重要的危险因素,因此,了解肾小管泌氢功能能否早期反映移植物的功能情况有重要意义。目的:观察肾移植患者术后肾小管泌氢功能,并进行监测,探讨其在移植物急慢性排斥中的作用。设计:病例-对照观察。单位:解放军济南军区总医院泌尿外科。对象:选择2000-05/2005-06解放军济南军区总医院泌尿外科连续实施肾脏移植26例患者,男16例,女10例;年龄21～58岁,平均35岁。原发病均为慢性肾小球肾炎,慢性肾功能衰竭,全部为尸肾移植。供受者均血型相同、淋巴细胞毒试验阴性。其中1例为第2次移植。所有患者对检测项目知情同意。方法:依据典型的临床表现,彩色多普勒超声及血流变化诊断患者排斥反应,16例患者未发生排斥反应为稳定组,10例发生排斥反应的患者为排斥组,排斥组根据排斥情况分为排斥前期、排斥期及恢复期。对所有患者术前及术后1周起每周1次,连续10周分别以化学清洁玻璃瓶留取晨起中段尿测定尿可滴定酸、NH4+和净酸水平评估肾小管泌氢功能。主要观察指标:两组患者尿可滴定酸、NH4+和净酸水平。结果:纳入患者26例均进入结果分析。排斥反应组排斥前期患者肾小管泌氢功能各检测值显示泌氢功能开始建立,并趋向正常,排斥期患者肾小管泌氢功能检测值均显示明显下降,与排斥前期及稳定组比较均有统计学显著性差异(P<0.01)。恢复期患者排斥反应治疗后监测的结果显示泌氢功能恢复较快。肾小管泌氢功能总体连续观察结果显示总体恢复的不均衡性,大部分病例恢复时间从1～10周不等,平均恢复期限约6周,2例10周内未恢复,4例严重排斥者中3例治疗后泌氢功能恢复缓慢。结论:肾小管泌氢功能可弥补血清肌酐不能良好反映肾小管功能的不足,能在连续观察中对移植肾急性排斥反应的诊断,特别是对抗排斥治疗的效果判断和预后评估中作为有价值的指标。

BACKGROUND： Acute rejection is a main complication and the major risk factors of chronic rejection and chronic graft dysfunction （CGD） after renal transplantation. Therefore, it is significant to investigate the effect of hydrogen ion excretion of renal tubule on the early diagnosis of the dysfunction of graft in renal transplantation patients. OBJECTIVE： To explore the effect of the hydrogen ion excretion of renal tubule on the diagnosis and efficacy of acute and chronic rejection of graft after renal transplantation. DESIGN ： Case-controlled observation SETTING： Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA. PARTICIPANTS： A total of 26 patients after successive renal transplantation were enrolled at Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA from May 2000 to June 2005. The age of all patients ranged from 21-58 years with an average of 35 years, including 16 males and 10 females. Recipients＇ primary diseases were chronic glomerulonephdtis （CGN） and chronic renal function failure （CRF）. One patient was in the 2nd transplantation. All patients received cadaveric renal transplantation. Donors and recipients had the same blood type and negative of lymphocytotoxicity test. All patients singed the informed consent. METHODS： According to clinical symptoms and bloodstream tested by color Doppler ultrasound, 16 patients without rejection were considered as stabilization group and 10 patients with rejection as rejection group. The rejection group was divided into prerejection, rejection and recovery phases. Medistream urine was collected with clean chemical glass bottle in the morning before operation and at week 1 after operation, once a week for successively 10 weeks. Urine titratable acid, NHZ and net acidity levels were measured to evaluate hydrogen ion excretion of renal tubule. MAIN OUTCOME MEASURES： Urine titratable acid （TA）, NH4^＋ and net acid excretion capacity （NAC） levels of patients in the two groups. RESULTS： Totally 26 patients were involved in the result analysis. Hydrogen ion excretion of renal tubule examination showed that the hydrogen ion excretion was intended to normal in rejection prophase patients. The hydrogen ion excretion of renal tubule was significantly decreased in the rejection phase patients, compared with those in the rejection prophase patients and patients of stabilization group （P 〈 0.01 ）. The hydrogen ion excretion of renal tubule was recovered rapidly in the most acute rejective patients after treatment. The recovery of hydrogen ion excretion of renal tubule was various. The recovery time of most cases ranged from 1-10 weeks with an average of about 6 weeks, 2 cases did not recover in 10 weeks and 3 cases of 4 severe rejection cases had slow recovery after treatment.CONCLUSION ： Hydrogen ion excretion of renal tubule can bridge the gap of bad reflection of renal tubule function from serum creatinine （Scr） and can diagnose the acute rejection after renal transplantation in continuous observation, and especially can be as a valuable index to assess curative effect and prognosis of rejection treatment.