乌司他丁对术后早期移植肾功能恢复的临床观察

Effect of ulinastatin in promotion of graft recovery in early stage after kidney transplantation:a cfinical study

目的探讨乌司他丁(UTI)对早期移植肾功能恢复尤其在促进急性肾小管坏死(ATN)恢复中的作用及其机制分析。方法普通尸肾移植患者30例,随机分成 A 组(用药组,15例)和 B 组(对照组,15例)。再选取具有急性肾小管坏死(ATN)高危因素的供肾,接受移植的患者共40例,按随机配对原则分成 C 组(用药组,20例)和 D 组(对照组,20例)。用药组于围手术期使用 UTI,观察术后早期尿量、血肌酐(sCr)、血α_1-微球蛋白(α_1-MG)、尿α_1-MG、IL-8、IL-10。结果 A 组与 B 组相比术后尿量增加,其中第2、6、7、9、10天比较差异有统计学意义(均 P<0.05);A 组术后第1、3天血IL-8分别为(93.8±31.5)ng/L 及(42.0±24.0)ng/L,显著低于 B 组(135.0±31.2)ng/L 及(178.3±76.4)ng/L,均 P<0.05;A 组术后第1、3天尿α1-MG 分别为(69.9±32.6)mg/L 及(35.3±34.5)mg/L,显著低于 B 组(91.2±28.4)mg/L 及(65.8±33.4)mg/L,P<0.05。C 组术后第7、10天血α_1-MG(118.3±41.2)mg/L、(99.5±68.6)mg/L 显著低于 D 组(187.2±55.2)mg/L、(151.3±87.4)mg/L,均 P<0.05;尿α1-MG 在术后第7天(39.9±22.3)mg/L 及第10天(38.2±20.4)mg/L,亦显著低于 D 组(67.3±21.6)mg/L 及(62.3±29.2)mg/L,均 P<0.05;C 组与 D 组比较术后血IL-8的升高趋势得到抑制,多尿期提前。结论 UTI 在肾移植术后能起到明显的改善微循环,保护移植肾小管,增加尿量,抑制炎症反应以及促进 ATN 恢复的作用。

Objective To investigate the effects of ulinastatin （ UTI）, a urinary trypsin inhibitor, on the promotion of the function recovery of transplanted kidney, especially for those with acute tubular necrosis （ATN）. Methods Thirty patients underwent general cadaver kidney transplantation were randomly allocated to 2 equal groups ： Group A （ UTI-treatment group） and Group B （ control group）. 40 patients whose allografts were presumed to be with acute tubular necrosis （ ATN ） were also divided into 2 equal groups： Group C （UTI-treatment group ） and Group D （control group ）. Group A and C were given ulinastatin perioperatively. 1, 3, 7, and 10 days after the transplantation blood and urine samples were collected. The levels of urine and blood α1-microglobulin （MG） were detected by radioimmunoassay. Blood IL-8, IL-10, and serum creatine （sCr） were detected by ELISA. Results Within 10 days after the transplantation the urine volume of Group A significantly increased, especially the urine volumes of days 2, 6, 7, 9, and 10 were significant greater than those of Group B （all P 〈0.05）. The levels of blood IL-8 of Group A in days 1 and 3 were （93.75 ± 31.5 ） ng/L and （41.98 ± 24.01 ） ng/L respectively, significantly lower than those of Group B [ （ 135.0 ± 31.2） ng/L and （78.34 ± 76.39） ng/L respectively, both P 〈 0. 05 ]. The levels of urine cd-MG in days 1 and 3 were （69.89 ± 32.60） mg/L and （35.33 ± 34.54） mg/L respectively, both significantly lower than those of Group B [ （91.15 ± 28.39） mg/L and （65.84 ± 33.38） mg/L respectively, both P 〈 0.05 ]. In group C, the levels of blood α1-MG in days 7 and 10 of Group C were （ 118.26 ± 41.23 ） mg/L and （99.49 ± 68.63 ） mg/L respectively, both significantly lower than those of Group D [ （ 187. 15 ± 55.23） mg/L and （ 151.27 ± 87.42） mg/L respectively, both P 〈 0. 05]. The urine α1-MG in days 7 and 10 were （39.89 ± 22.32） mg/L and （38.21 ± 20.36） mg/L respectively, both significantly lower than those of Group D [ （67.34 ±21.56） mg/L and （62.26 ±29.24） mg/L respectively, both P 〈 0.05 ]. Compared to Group D, the increasing tendency of blood IL-8 was better suppressed in Group C, and the diuretic phases appeared earlier. Conclusion UTI significantly improves the microcirculation, protects the tubule of transplanted kidney, increases the volume of urine, inhibits the inflammatory response, and promotes the recovery of ATN during the perioperative period of kidney transplantation.