早期移植肾功能恢复中尿肾损伤分子1的监测价值

Detction of urinary kidney injury molecule-1 for diagnosis of early graft function in kidney transplantation

背景:肾损伤分子1已被证实是一种诊断急性肾缺血损伤的特异性分子并参与肾损伤修复过程,研究表明肾损伤分子1可作为诊断移植肾肾小管上皮细胞损伤的标志物,但其在早期移植肾功能恢复过程中动态表达的意义尚未见报道。目的:观察肾移植后尿肾损伤分子1含量和早期肾功能恢复的关系,为临床更好地评估及预测移植肾功能恢复能力提供依据。方法:纳入46例肾移植受者,根据早期肾功能恢复情况分为3组,肾功能迅速恢复组22例,肾功能缓慢恢复组14例,肾功能延迟恢复组10例。肾移植后2周内每天收集24h尿液标本,用ELISA方法检测尿液肾损伤分子1含量,同时检测尿液肌酐浓度和当天血清肌酐浓度。观察肾功能恢复过程中尿肾损伤分子1含量变化,并分析尿肾损伤分子1含量和血清肌酐浓度变化的关系。结果与结论:各组肾移植后2d内尿肾损伤分子1含量处于高水平状态,组间差异无显著性意义(P>0.05)。肾移植2d后肾功能迅速恢复组尿肾损伤分子1含量随肌酐的下降而迅速下降;肾功能缓慢恢复组尿肾损伤分子1含量持续处于高水平状态,肌酐正常后开始下降;肾功能延迟恢复组尿肾损伤分子1含量迅速下降,但在肌酐开始下降的前一两天迅速上升并持续到肌酐恢复正常。提示尿肾损伤分子1动态检测对预测肾移植后肾功能恢复有重要意义,肾损伤分子1水平高可能预示肾功能的恢复。

BACKGROUND：Urinary kidney injury molecule-1（KIM-1）has been proved to be a novel kidney-specific injury molecule as a marker for the diagnosis of acute renal ischemia injury,and KIM-1 participated in the progress of renal injury repair.However,no one reported the significance of its dynamic expression during the functional rehabilitation of renal graft.OBJECTIVE：To investigate the relations between urinary KIM-1 level and the early renal graft function in order to provide rational approaches for evaluating or predicting early renal graft function.METHODS：The 46 patients were divided into 3 groups,including 22 cases of immediate graft function（IGF）,14 cases of slow graft function（SGF）and 10 cases of delayed graft function（DGF）.The 24-hour urine specimen was collected every day for 2 weeks since the operation.The urinary KIM-1 content was detected by enzyme linked immunosorbent assay（ELISA）,and at the same time the urinary and serum creatinine levels were detected.The diversity of urinary KIM-1 level was observed during the recovery of the graft function,and the clinical significance was evaluated by analyzing the correlation of urinary KIM-1 level and serum creatinine.RESULTS AND CONCLUSION：At the first 2 days after kidney transplantation,the urinary KIM-1 levels were high and no significant difference was observed between the three groups（P 0.05）.Two days later,the urinary KIM-1 level descended quickly along with the descent of the serum creatinine in IGF and SGF groups;the urinary KIM-1 maintained high levels until the serum creatinine reached normally.In DGF group,the urinary KIM-1 decreased quickly to a low level after 2 days from operation,but it increased promptly 1 to 2 days before the recovery of graft function and kept a high level until the serum creatinine reached normally.This suggested that consecutive detection of urinary KIM-1 is useful for monitoring the early graft function after kidney transplantation,and high urinary KIM-1 may suggest the recovery of graft function.