肾移植患者术后血清半胱氨酸蛋白酶抑制剂C和肾功能的动态变化观察

Studies on the change of serum cystatin C and renal function in post kidney transplanted patients

目的通过连续监测肾移植患者术后血清半胱氨酸蛋白酶抑制剂C(Cys C)和肾功能[尿素(Urea)、肌酐(Cr)、尿酸(UA)]的变化规律及其相互关系,探讨血清Cys C在肾移植术后动态监测中的应用价值。方法选取18例术后无明显并发症和急性排异反应的同种异体肾移植患者,分别在术前1 d和术后1、2、3、5、7、10、14、20、30 d清晨空腹抽血,采用免疫透射比浊法检测血清Cys C以及采用酶法分别检测血清Urea、Cr、UA浓度,同时选20例健康体检者作为正常对照组。结果血清Cys C和Cr在肾移植术后第1天、第2天急剧下降,但Cys C下降的幅度比Cr大,在术后第3天后两者浓度基本上恢复正常,与正常对照组比较差异均无统计学意义(P均>0.05)。血清Urea、UA在肾移植术后第1天、第2天急剧下降,但第5天又开始升高,第10天后又重新开始下降,Utea浓度均显著高于正常对照组(P均<0.001),UA浓度和正常对照组相比差异无统计学意义(P>0.05)。Cys C和Cr、Urea、UA呈正相关[相关系数(r)分别为0.828、O.593、0.432,P均<0.001]。结论血清Cys C和Cr检测方法简便、快捷,且能准确判断移植肾功能。对肾移植患者术后进行该2项指标的连续监测将有助于准确掌握移植肾功能状态,制订合理的个体化免疫抑制方案。

Objective To determine the diagnostie value of serum evstatin C（Cys C ） in dynamic monitoring of kidhey transplanted patients by ohserving continuously the ehange and relationship between Cvs C and renal function （ urea, ereatinine [Cr], uric aeid[UA）. Methods Tbe serum Cys C, urea, Cr and UA were followed in 18 patients （luring one day before operation and 1.2,3,5,7,10,14,20.30 d after operation. The level of Cvs C was measured by particleenhanced turbimetric immunoassay. The levels of urea, Cr and UA were measured by enzymatie methods. 20 healthy people were enrolled as controls, Results The levels of Cvs C and Cr were decreased rapidly at 1 d and 2 d after kidney transplantation, but the decreased extent of Cys C was greater than Cr. Tile levels of Cys C and Cr returned tu norreal at 3 d after operation, and no difference compared with normal controls, The levels of urea and UA decreased rapidly at 1 d and 2 d after kidney transplantation, but inereased gradually after 5 d and decreased again after 10 d, The level of serum urea of patients with kidney transplanted in these days was significantly higher than that in control group（ P 〈 0. 001 ） ; Bul lhere were no significant differenees belween the levels of UA in kidney transplanted palients and euntrul group （ P 〉 0.05 ）. The level of Cvs C was positively currelated with Cr（ r = 0. 828, P 〈 0. 001 ） . urea （ r = 0. 593, P 〈 0.001 ） and UA（r =0. 432, P 〈0. 001）. Conclusions The serum Cys C and Cr detemination is rapid, convenient, and could judge with aeeuracy the funetion of transplanted kidney. So it is helpful to know aeeurately lhe renal funetion after transplantatiun and make a reasonable individual immunosuppressant lherapy by monitoring serum Cys C and Cr of kidney transplanted patients eontinuously.