肾细胞癌患者血清Nrf2水平与肾切除术后肾功能下降及生存预后的关系

Relationship between serum Nrf2 level and renal function decline and survival prognosis in patients with renal cell carcinoma after nephrectomy

目的探讨肾细胞癌(RCC)患者血清核因子红细胞2-相关因子2(Nrf2)水平与肾切除术后肾功能下降及生存预后的关系。方法选取2015年3月至2020年12月在我院接受肾切除术治疗的128例RCC患者,采用ELISA法检测术前血清Nrf2水平;利用慢性肾脏病流行病学协作方程计算患者术前和术后估计肾小球滤过率(eGFR)。结果RCC患者的术前血清Nrf2水平与术后1个月eGFR变化值(ΔeGFR)及术后1年ΔeGFR呈正相关(P<0.05)。根据术前血清Nrf2中位值将患者分为低Nrf2组(<9.58 ng/ml)和高Nrf2组(≥9.58 ng/ml),高Nrf2组和低Nrf2组术后中位生存时间分别为38和49个月,总生存率分别为26.6%和60.9%;术前血清Nrf2水平升高与总生存时间缩短相关(Log Rankχ^(2)=15.334,P<0.001)。经Cox风险比例回归分析显示,世界卫生组织/国际泌尿病理学会(WHO/ISUP)分级、T分期、远处转移和术前血清Nrf2水平是肾切除术后预后较差的独立预测因子(P<0.05)。结论血清Nrf2水平升高与肾切除术后肾功能下降风险有关,且术前血清Nrf2水平升高是RCC患者术后预后较差的独立预测因子。

Objective To investigate the relationship between serum nuclear factor erythroid 2-related factor 2(Nrf2)level and renal function decline and survival prognosis in patients with renal cell carcinoma(RCC)after nephrectomy.Methods A total of 128 patients with RCC who underwent nephrectomy in our hospital from March 2015 to December 2020 were selected.Preoperative serum Nrf2 levels were measured by enzyme-linked immunosorbent assay.Estimated glomerular filtration rate(eGFR)was calculated preoperatively and postoperatively using the Chronic Kidney Disease Epidemiology Collaborative Equation.Results For RCC patients,the preoperative serum Nrf2 level was positively correlated with eGFR change value(ΔeGFR)at 1 month after operation andΔeGFR at 1 year after operation(P<0.05).According to the median value of preoperative serum Nrf2,patients were divided into low Nrf2 group(<9.58 ng/ml)and high Nrf2 group(≥9.58 ng/ml).The median survival time of the high Nrf2 group and the low Nrf2 group were 38 and 49 months,respectively,and the overall survival rate were 26.6%and 60.9%,respectively.The preoperative serum Nrf2 level was correlated with the shortening of the overall survival time(Log Rankχ2=15.334,P<0.001).The Cox hazard ratio regression analysis showed that WHO/ISUP grade,T stage,distant metastasis and preoperative serum Nrf2 expression were independent predictors of poor prognosis(P<0.05).Conclusions Elevated serum Nrf2 level is associated with the risk of renal function decline after nephrectomy,and preoperative elevated serum Nrf2 level is an independent predictor of poor postoperative prognosis in RCC patients.