炎症标志物在心脏移植后急性细胞排斥反应中的诊断价值

Diagnostic usefulness of inflammatory markers in acute cellular rejection after heart transplantation.

作者信息

Sánchez-Soriano R M, Almenar L, Martínez-Dolz L, Reganon E, Martínez-Sales V, Chamorro C I, Vila V, Martín-Pastor J, Villa P, Salvador A

机构信息

Cardiac Failure and Transplant Unit, La Fe University Hospital, Valencia, Spain.

出版信息

Transplant Proc. 2006 Oct;38(8):2569-71. doi: 10.1016/j.transproceed.2006.09.002.

DOI:10.1016/j.transproceed.2006.09.002

PMID:17098005

Abstract

BACKGROUND

Acute cellular rejection (ACR) affects early morbidity and mortality after heart transplantation. The diagnostic technique of choice is endomyocardial biopsy. Our aim was to evaluate the diagnostic usefulness of inflammatory markers as a noninvasive method to monitor cellular rejection.

MATERIAL AND METHODS

We prospectively analyzed 73 cardiac transplant patients by determining the serum levels of protein fibrinogen (fgpro), functional fibrinogen (fgfun), C-reactive protein (CRP), and sialic acid (SA) coinciding with an endomyocardial biopsy (5.1 revisions/patient). The statistical methods were chi(2), Student's t-test, and ROC curves.

RESULTS

Of the 373 controls, significant rejection was detected in 19%. Analysis of the relationship between ACR and the markers showed significantly elevated levels of fgpro (345 +/- 90 versus 307 +/- 74 mg/dL; P = .03), fgfun (361 +/- 101 versus 318 +/- 89 mg/dL; P = .04), and SA (74 +/- 22 versus 66 +/- 15 mg/dL; P = .02), but not CRP (19 +/- 29 versus 10 +/- 21 mg/dL; P = .07). SA displayed a better diagnostic utility (area under the curve 0.7; P < .01), 35% sensitivity, 85% specificity, and 82% negative predictive value for a cutoff point of 80 mg/dL.

CONCLUSIONS

Among the inflammatory markers increased in ACR, SA was the most useful noninvasive tool for screening.

摘要

背景

急性细胞排斥反应（ACR）影响心脏移植后的早期发病率和死亡率。首选的诊断技术是心内膜心肌活检。我们的目的是评估炎症标志物作为监测细胞排斥反应的非侵入性方法的诊断效用。

材料与方法

我们前瞻性分析了73例心脏移植患者，测定了与心内膜心肌活检（每位患者5.1次复查）同时进行的血清纤维蛋白原（fgpro）、功能性纤维蛋白原（fgfun）、C反应蛋白（CRP）和唾液酸（SA）水平。统计方法为卡方检验、学生t检验和ROC曲线。

结果

在373例对照中，19%检测到明显排斥反应。对ACR与标志物之间关系的分析显示，fgpro（345±90对307±74mg/dL；P = 0.03）、fgfun（361±101对318±89mg/dL；P = 0.04）和SA（74±22对66±15mg/dL；P = 0.02）水平显著升高，但CRP未升高（19±29对10±21mg/dL；P = 0.07）。对于80mg/dL的截断点，SA显示出更好的诊断效用（曲线下面积0.7；P < 0.01），敏感性为35%，特异性为85%，阴性预测值为82%。