肾移植患者血清铁调素水平与术后感染的关系

Relationship between serum hepcidin level and postoperative infection in renal transplant patients

目的探究肾移植患者血清铁调素(Hepcidin)基线水平与术后一年感染及不良预后的关系。方法选择2015年9月-2018年9月于湖北省第三人民医院进行肾移植手术的患者84例为研究对象,收集患者术前基本信息,如性别、年龄、术前并发症、术前透析方式、平均透析时间及器官捐献方式以及患者的感染部位、病原等临床资料,采用双夹心抗体酶联免疫吸附法(Enzyme-linked immuno sorbent assay,ELISA)对血清Hepcidin水平进行检测。结果肾移植术后一年,84例受体共有65例在随访期间发生感染,感染率为77.38%。感染部位以尿路感染、胃肠道感染和手术部位感染为主;以细菌感染发生率最高(60.71%);感染组基线Hepcidin为(89.36±35.81)ng/ml高于非感染组(P=0.003);ROC分析结果显示基线Hepcidin对肾移植受体术后感染具有良好的预测价值,计算得出其Cut-off值为75.0ng/ml;基线Hepcidin水平≥75ng/ml肾移植受体术后一年尿路感染、总感染发生率分别为29.41%(15/51)、94.12%(48/51)高于基线Hepcidin水平<75ng/ml肾移植受体(P<0.05),基线Hepcidin水平≥75ng/ml肾移植受体死亡率为19.61%(10/51)高于<75ng/ml的肾移植受体,但差异无统计学意义(P=0.369)。结论基线Hepcidin水平与肾移植受者术后感染发生及不良结局预测存在紧密联系,其在肾移植受者术后感染中可能起到重要的调节作用。

OBJECTIVE To explore the relationship between the baseline level of serum hepcidin in renal transplant recipients,infection and poor prognosis one year after surgery.METHODS The 84kidney transplant recipients who underwent kidney transplantation at the Third People′s Hospital of Hubei Province from Sept.2015to Sept.2018were selected as the research subjects.Basic information such as gender,age,preoperative complications,preoperative dialysis,and average dialysis time and organ donation methods,as well as the patients’infection site,pathogens and other clinical data were collected.Serum hepcidin levels were detected by double sandwich antibody ELISA.RESULTS One year after kidney transplantation,a total of 65of 84recipients were infected during the follow-up period,and the infection rate was 77.38%.The main infection sites were urinary tract infections,gastrointestinal infections and surgical site infections;the incidence of bacterial infections was the highest(60.71%);the baseline hepcidin in the infection group was(89.36±35.81)ng/ml,significently higher than that in the non-infected group(P=0.003);ROC analysis results showed that baseline Hepcidin had a good predictive value for postoperative infection of renal transplant recipients,and its Cut-off value was calculated to be 75.0ng/ml.The incidence of urinary tract infection and total infections of kidney transplant recipients with a baseline Hepcidin level≥75ng/ml one year after kidney transplantation were 29.41%(15/51),94.12%(48/51),respectively,significently higher than the baseline Hepcidin level<75ng/ml kidney transplant recipients(P<0.05).The mortality rate of kidney transplant recipient with a baseline Hepcidin level≥75ng/ml was 19.61%(10/51),higher than that of kidney transplant recipients with a baseline less than 75ng/mL,but the difference was not significant(P=0.369).CONCLUSIONBaseline hepcidin levels was closely related to the occurrence of postoperative infection and adverse outcome prediction in renal transplant recipients,which may play an important regulatory role in postoperative infection in renal transplant recipients.