联合检测MA、BUN、sCr、eGFR在他克莫司致移植肾早期损伤发生中的诊断价值

Application of combined detection of MA,BUN,sCr and eGFR in early renal graft injury induced by tacrolimus

目的 联合检测尿微量白蛋白(MA)、血尿素氮(BUN)、血肌酐(sCr)和估算的肾小球滤过率(eGFR)在评估肾移植后患者因使用他克莫司(Tac)所致的移植肾功能损伤早期发现的临床价值。方法 选取2015年8月—2020年7月宁波市泌尿肾病医院收治的长期使用Tac的肾移植患者54例,同一患者根据Tac持续使用的时间分为12个月组(A组)、24个月组(B组)进行比较分析,以评估MA、BUN、sCr、eGFR以及联合检测的临床价值。结果 比较发现,B组MA、eGFR较A组差异均有统计学意义(P<0.05),但BUN、sCr组间差异均无统计学意义(P>0.05)。eGFR与MA、BUN、sCr均呈负相关关系[用药12个月组(A组)和用药24个月(B组)r值分别为-0.413、-0.538、-0.797(P<0.01)和-0.333、-0.647、-0.738(P<0.05)],且与Tac持续使用时间具有相关性,在移植后早期相关性更为显著。受试者工作特征曲线显示,MA、BUN、sCr、eGFR单独检测的AUC分别为0.680、0.594、0.581、0.689,4项指标联合检测时AUC为0.839。结论 MA、BUN、sCr、eGFR四项肾功能损伤标志物联合检测对肾移植后持续使用Tac患者肾功能损伤的发生具有早期诊断价值。

Objective To assess the clinical value of early detection of the risk of graft dysfunction in post-renal transplant patients after continued use of tacrolimus(Tac) by combined detection of urinary microalbumin(MA),blood urea nitrogen(BUN),serum creatinine(sCr) and estimated glomerular filtration rate(eGFR).Methods Fifty-four renal transplant patients who had been using Tac for a long time and were admitted to Ningbo Hospital for urinary nephropathy between August 2015 and July 2020 were selected.The patients were divided into two groups:group A,which used Tac continuously for 12 months,and group B,which used Tac continuously for 24 months.The clinical value of MA,BUN,sCr,eGFR and combined detection were evaluated through comparative analysis.Results Compared to group A,group B showed significant differences in MA and eGFR(P<0.05),but not in BUN and sCr(P>0.05).There was a negative correlation between eGFR and MA,BUN and sCr [r values of 12 months(group A) and 24 months(group B) were-0.413,-0.538,-0.797(P<0.01) and-0.333,-0.647,-0.738(P<0.05),respectively],and was significantly correlated with Tac duration,particularly in the early post-transplantation period.Based on the receiver operating characteristic curve,the AUC for MA,BUN,sCr and eGFR individually were 0.680,0.594,0.581 and 0.689,respectively.The combined detection of the four indicators resulted in an AUC of 0.839.Conclusion The detection of four renal injury markers(MA,BUN,sCr and eGFR) can aid in the early diagnosis of renal insufficiency in patients who continue to use Tac after renal transplantation.