尿微量蛋白检测对移植肾早期功能损害的诊断价值

Determination of urinary microprotein as a marker of early renal damage in renal transplants

目的探讨尿微量蛋白检测对肾移植患者术后早期肾功能损害的诊断价值。方法 200例肾移植患者(肾移植组)按移植术后时间长短分层随机抽样,分为5组:术后1～3个月组,术后4～11个月组,术后1～5年组,术后6～10年组,术后10年以上组,每组40例。另随机抽取拟行肾移植术而进行术前检查的尿毒症患者20例为尿毒症对照组。用速率散射比浊法分别对6组患者的清洁新鲜中段尿进行尿微量蛋白测定与尿蛋白定性检测,同时采用全自动生化仪检测血清肌酐(Scr)。结果与术后1～3个月组比较,术后4～11个月组的尿α1-微球蛋白即开始升高(P<0.05),术后1～5年组、6～10年组尿微量白蛋白、尿转铁蛋白明显升高(均为P<0.05)。术后10年以上组尿微量白蛋白、尿α1-微球蛋白、尿转铁蛋白、尿免疫球蛋白(Ig)G均明显升高(均为P<0.05)。术后10年以上组尿蛋白阳性率明显高于其它时间组(均为P<0.05)。肾移植术后不同时间Scr水平比较差异无统计学意义(均为P>0.05)。结论尿微量蛋白的变化较尿蛋白定性及Scr的改变更为敏感,宜作为早期移植肾功能受损的常规监测指标。

Objective To investigate the diagnostic value of urinary microprotein determining for early renal damage in renal transplant recipients.Methods According to the length of time post-transplantation,200 cases of renal transplant recipients（renal transplantation group）were divided into 5 groups（40 cases in each group）by stratified random sampling,including group of patients within 1-3 months after transplantation,group of patients within 4-11 months after transplantation,group of patients within 1-5 years after transplantation,group of patients within 6-10 years after transplantation,group of patients over 10 years after transplantation.And then,20 uremic patients who had preoperative examination were randomly selected as control group.The levels of urinary microprotein in clean catch midstream urine were determined in all patients in 6 groups by rate scattering nephelometry method.Qualitative analysis of urine protein was also made simulta-neously and the serum creatinine（Scr）was detected by automatic biochemistry analysator.Results Compared with the group of patients within 1-3 months after transplantation,the urinary α1-microglobin began to increase in group of patients within 4-11 months（P〈0.05）,and urinary microalbumin and transferin increased significantly in groups of patients within 1-5 years and 6-10 years after transplantation（all in P〈0.05）.Urinary microalbumin,α1-microglobin,transferrin and immunoglobulin（Ig）G were all increased significantly in group of patients over 10 years after transplantation（all in P〈0.05）.Urine protein positive rate in group of patients over 10 years after renal transplantation were significantly higher than other groups（all in P〈0.05）.But there was no significant difference in Scr level in all groups（all in P〈0.05）.Conclusions The change of urinary microprotein is more sensitive than qualitative analysis of urine protein as well as the level of Scr.So it may be usd as a routine method in monitoring early damage of kidney transplants.