心脏移植患者术后尿液管型阳性率及其影响因素

Positive rate of urine cast after heart transplantation and its influencing factors

目的分析心脏移植术后患者尿液管型的阳性率及其影响因素。方法收集2023年3月1日—6月31日华中科技大学同济医学院附属协和医院门诊定期复查的143例心脏移植术后患者的尿液样本,行管型镜检,根据镜检结果分为管型阳性组和管型阴性组,比较2个组一般临床资料和相关实验室检测结果差异。采用Logistic回归分析评估心脏移植术后患者尿液管型阳性的影响因素。采用受试者工作特征(ROC)曲线评估相关指标预测心脏移植术后患者尿液管型阳性的效能。结果143例患者尿液管型阳性率为39.2%(56/143)、病理管型阳性率为42.9%(24/56);管型阳性样本中干化学尿蛋白阴性样本占75.0%(42/56)(即易漏检率为75.0%),移植<1年、1~3年、>3年的患者尿液管型阳性率分别为57.5%(23/40)、12.2%(5/41)、45.2%(28/62)。管型阳性组和管型阴性组移植时间、尿素氮、血清肌酐(SCr)、胱抑素C、肾小球滤过率和他克莫司使用情况差异有统计学意义(P<0.05);性别、年龄、糖尿病史、高血压病史、干化学尿蛋白、尿酸、直接胆红素、B型钠尿肽、射血分数、空腹血糖和糖化血红蛋白差异均无统计学意义(P>0.05)。移植时间<1年[比值比(OR)值为5.537,95%可信区间(CI)为1.669~18.372,P=0.001]、移植时间>3年[OR值为7.442,95%CI为2.307~24.009,P=0.005]和他克莫司≥8.3 ng·m L^(–1)[OR值为2.781,95%CI为1.164~6.640,P=0.021]是心脏移植术后患者尿液管型阳性的独立危险因素。多指标联合检测判断心脏移植患者术后尿液管型阳性的曲线下面积为0.810,敏感性为89.3%,特异性为64.4%。结论心脏移植术后患者尿液管型阳性率较高,且易漏检。临床应关注移植时间<1年、移植时间>3年和他克莫司≥8.3 ng·m L^(–1)的心脏移植术后患者尿液管型检出情况。

Objective To analyze the positive rate of urine cast in patients after heart transplantation and its influencing factors.Methods From March 1 to June 30,2023,the urine samples of 143 patients undergoing heart transplantation were collected from the Outpatient Department of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology.The urine samples were determined by cast microscopy and classified into cast positive group and cast negative group.The differences of general clinical data and relevant laboratory determination results were compared between cast positive group and cast negative group.Logistic regression analysis was used to evaluate the influencing factors of positive urine cast in patients after heart transplantation.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of relevant indicators in predicting positive urine cast in patients after heart transplantation.Results The positive rate of urine cast was 39.2%(56/143),and the positive rate of pathological cast was 42.9%(24/56).In positive urine cast samples,the proportion of dry chemical urine protein negative samples was 75.0%(42/56)(easy to miss rate 75.0%).The positive rates of urine cast were 57.5%(23/40),12.2%(5/41)and 45.2%(28/62)in the samples of<1 year,1-3 years and>3 years after transplantation,respectively.There was statistical significance in transplantation time,urea nitrogen,serum creatinine(SCr),cystatin C,glomerular filtration rate and tacrolimus use between cast positive and cast negative groups(P<0.05).There was no statistical significance in gender,age,history of diabetes mellitus,history of hypertension,dry chemical urine protein,uric acid,direct bilirubin,B-type natriuretic peptide,ejection fraction,fasting blood glucose and glycated hemoglobin Alc(P>0.05).The transplantation time<1 year[odds ratio(OR)was 5.537,95%confidence interval(CI)1.669-18.372,P=0.001],the transplantation time was>3 years(OR=7.442,95%CI 2.307-24.009,P=0.005)and tacrolimus≥8.3 ng·mL^(–1)(OR=2.781,95%CI 1.164-6.640,P=0.021)were independent risk factors for positive urine cast after heart transplantation.The area under curve of multi-indicator combined determination for positive urine cast after heart transplantation was 0.810,the sensitivity was 89.3%,and the specificity was 64.4%.Conclusions The positive rate of urine cast after heart transplantation is high,and it is easy to miss determination.Clinical attention should be paid to the determination of urine cast in patients with transplantation time<1 year,transplantation time>3 years and tacrolimus≥8.3 ng·mL^(–1).