【作者】 周士明；

【导师】 田军；

【作者基本信息】 山东大学 ， 血液净化、肾脏移植， 2008， 硕士

【摘要】 目的：1．找到一种用于肾移植后肾功能检测的新指标，初步应用于肾移植后移植物功能的检测，并探讨其水平与移植肾功能(肾小球滤过率)的关系。2．通过对术后半胱氨酸蛋白酶抑制剂C、血清肌酐(sCr)、尿素氮(BUN)各项指标的比较，探讨半胱氨酸蛋白酶抑制剂C作为早期肾功能损伤评估指标的应用价值。方法：采用回顾性分析方法，70例肾移植患者术后一月内动态监测血清肌酐、半胱氨酸蛋白酶抑制剂C，并用Modification of Diet in Renal Disease equation(MDRD公式)计算内生肌酐清除率。研究对象分为肾功能正常组(A组，31例，GFR≥90ml／min／1．73m~2)、轻度受损组(60≤GFR<90ml／min／m~2)组和肾功能中重度受损组(D组，4例，GFR<60ml／min／m~2)．依据血清肌酐正常与否，肾功能轻度受损组又分为肌酐正常组(B组，23例，Scr≤133μmol／L)和肌酐异常组(C组，12例，Scr>133μmol／L)。并与正常对照组(60例)相比较。分别绘制各组Cys C和SCr与CCr关系的散点图，并求出相关系数r。采用免疫增强散射比浊法测定半胱氨酸蛋白酶抑制剂C的水平，以流式细胞术连续检测CD4／CD8比值，ELISA检测免疫抑制剂药物浓度，评估机体的免疫状态。血生化仪测定血肌酐、尿素氮。结果：1．健康正常对照人群半胱氨酸蛋白酶抑制剂C的浓度是(0．72±0．13)mg／L。血清肌酐浓度为(50．48±15．20)μmol／L。2．各组移植前半胱氨酸蛋白酶抑制剂C、血清肌酐、和尿素氮水平无显著差异(P>0．05)。3 A组半胱氨酸蛋白酶抑制剂C浓度为(0．96±0．10)mg／L．B组半胱氨酸蛋白酶抑制剂C浓度为(1．37±0．14)mg／L．与A组对照比较有统计学差异(P<0．05)。4．A组血清肌酐浓度为(90．51±9．86)μmol／L．B组血清肌酐浓度为(105．27±13．76)μmol／L．与A组对照比较无统计学差异(P>0．05)5．GFR在A、B、C组与SCr、Cys C均呈直线相关，其中r分别为-0．7272和-0．7439，-0．7072和-0．7543，-0．7430和-0．7669。结论：Cys C浓度在肾移植术后肾功能损伤早期检测中具有重要价值。在肌酐虽然正常但CCr已经降低的患者中，其浓度已有显著变化，Cys C与肌酐清除率在肾功能正常和轻度受损患者中均呈直线相关性，其相关系数与血肌酐相比，甚至优于血清肌酐。Cystatin C单项诊断肾功能损伤时变化更明显，性能优于其他指标。由于其不受体内分解代谢，饮食等因素干扰，所以可以应用于临床，作为肾移植术后肾功能检测的常规检测指标。外周血Cystatin C检测作为一个评估移植肾功能的指标具有无创性，结果显示Cystatin C具有很高的临床应用价值，可以简便、省时、准确的应用于大量的移植患者术后移植物功能的监测。更多还原

【Abstract】 Objects1 To find a new index to detect the renal function after renal transplantation. This index was used in detecting the graft function. Meanwhile we rearch the relationship between Cystatin C and GFR (glomerular filtration rate).2Through compared with Scr and BUN, to show the vulue of Cystatin C as an index in detecting the graft function after renal transplantation. And the value of cystatin C (Cys C) in the early detection of the graft function damagement after renal transplantation and providing evidence for the further diagnosis and treatment.MethodologyAt the twelfth day post-transplantation, monitored the concentration ofCys C, blood urea nitrogen (BUN) , Serum creatinine (SCr) and the glomerular filtration rate (GFR). GFR was determined by the Modification of Diet in Renal Disease equation (MDRD equation). According to the value of GFR post-transplantation, 70 cases of renal transplant patients were divided into group A (31 cases, with the normal renal function, GFR=90ml/min/1.73m~2), group B (Scr=133μmol/L, 60=GFR<90ml/min/1.73m~2, 27 cases), group C (Scr > 133μmol/L, 60=GFR<90ml/min/1.73m~2,12 cases) and group D (GFR < 60ml/min/1.73m~2, 4 cases). Meanwhile, the normal control group (n = 60) was compared. Analysis the linear correlation between Cys C, Scr and GFR through the scatterplots in each groups, and calculated the correlation coefficient(r). Determination of Cys C was performed using the Behring BN II Pro Spec analyzer. Meanwhile, used the automatic biochemistry analyzer and correlated kits to analysis the serum creatinine concentration.Results1. Cys C concentration in normal control group was 0.72±0.13 mg/L. Scr concentration was 50.48±15.20μmol/L.2. The concentration of Scr, Cystatin C and BUN had no conspicuous statistically significance (P>0.05), compared with the normal control pre-transplantation.3. Cys C concentration in group B (27 cases) were (1.37±0.14), the difference has conspicuous statistically significance (P<0.01), compared with that of group A (0.96±0.10) mg/L.4.Scr concentration in group B (27 cases) were (105.26±13.76)μmol/L, the difference has no statistically significance (P>0.05), compared with that of group A (90.51±9.86)μmol/L.5.Through the scatterplot, SCr and Cys C showed similar linear correlation with GFR in group A, B and C. The correlation coefficient (r) of each group was -0.7272 and -0.7439, -0.7072 and -0.7543, -0.7430 and -0.7669.ConclusionCys C concentration was not influenced by diet, infection. Compared with the Scr, Cys C has the similar relevance with GFR even better when the graft function was normal and lightly renal function damaged. After transplantation, when the grafts function was damaged slightly, the Cys C had a more sensitive changement, espiacially when the Scr concentration had not increased. This indicated that the Cys C had a more sensitively and intimate correlation with GFR. Cys C, as a rapid, sensitive index, could be used in the early diagnosis of renal function damage after renal transplantation.SignificanceOur study is useful for renal transplantation in order to enhance long-term survival. It can diagnose early damagement of the draft function and help doctors to adjust the dose of immunosuppressant.更多还原