Krzanowski Marcin, Stompór Tomasz, Kuśnierz-Cabala Beata, Ignacak Ewa, Sułowicz Władysław, Naskalski Jerzy W
Katedra i Klinika Nefrologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
Przegl Lek. 2006;63(8):597-601.
Chronic inflammation is an inherent feature of chronic renal failure. Successful renal transplantation (RTx) is the only known renal replacement therapy sufficient to reverse most of the metabolic disturbances of chronic uremia, although still some of these abnormalities may be present or even new problems may occur (mostly as the side effects of immunosuppressive drugs). The aim of this study was to evaluate the level of inflammation in 20 patients (9 F, 11 M, aged mean 44.0 +/- 11.8 years) with well-preserved renal function 36 months after kidney transplantation, using serum levels of selected cytokines (IL-6, IL-18, TNFalpha and soluble receptor for TNF - sTNFRII), acute phase proteins (CRP, fetuin A) and hepatocyte growth factor (HGF). Procalcitonin was also assessed as the sensitive indicator of active infection. Obtained results were compared with the control group of healthy subjects in a respective age. Serum levels of IL-6, TNF-R and IL-18 were significantly higher, and HGF and fetuin A--significantly lower in patients vs. controls (p < 0.05 for all differences). Significant negative correlations were noted between glomerular filtration rate (GFR) and serum TNF, sTNFRII and IL-18 in RTx patients, whereas strong positive relationship between GFR and fetuin A was observed. Serum creatinine correlated with IL-6, IL-18, TNFalpha, sTNFRII and hsCRP levels and serum urea-with TNFalpha, sTNFRII, IL-6 and IL-18. Significant negative associations were also noticed between serum fetuin A and most of the tested inflammatory markers: sTNFRII (r = -0.77; p = 0.0005), IL-6 (r = -0.63; p = 0.009), hsCRP (r = -0.62; p = 0.009) and IL-18 (r = -0.60; p = 0.01). Obtained results permit us to conclude that the increased activity of inflammation can still be noticed in RTx patients 36 months after successful engraftment. This process is inversely associated with the level of kidney function. The role of fetuin A as the 'negative' acute phase protein was also demonstrated in this group of patients.
慢性炎症是慢性肾衰竭的一个固有特征。成功的肾移植（RTx）是唯一已知的足以逆转慢性尿毒症大多数代谢紊乱的肾脏替代疗法，尽管仍可能存在一些这些异常情况，甚至可能出现新问题（主要是免疫抑制药物的副作用）。本研究的目的是通过检测选定细胞因子（IL - 6、IL - 18、TNFα和TNF可溶性受体 - sTNFRII）、急性期蛋白（CRP、胎球蛋白A）和肝细胞生长因子（HGF）的血清水平，评估20例肾移植后36个月肾功能良好的患者（9名女性，11名男性，平均年龄44.0±11.8岁）的炎症水平。降钙素原也作为活动性感染的敏感指标进行了评估。将获得的结果与相应年龄的健康受试者对照组进行比较。与对照组相比，患者血清中IL - 6、TNF - R和IL - 18水平显著升高，而HGF和胎球蛋白A水平显著降低（所有差异p < 0.05）。肾移植患者的肾小球滤过率（GFR）与血清TNF、sTNFRII和IL - 18之间存在显著负相关，而GFR与胎球蛋白A之间存在强正相关。血清肌酐与IL - 6、IL - 18、TNFα、sTNFRII和hsCRP水平相关，血清尿素与TNFα、sTNFRII、IL - 6和IL - 18相关。血清胎球蛋白A与大多数检测的炎症标志物之间也存在显著负相关：sTNFRII（r = - 0.77；p = 0.0005）、IL - 6（r = - 0.63；p = 0.009）、hsCRP（r = - 0.62；p = 0.009）和IL - 18（r = - 0.60；p = 0.01）。获得的结果使我们得出结论，在成功移植36个月后，肾移植患者仍可观察到炎症活动增加。这个过程与肾功能水平呈负相关。在这组患者中也证实了胎球蛋白A作为“负性”急性期蛋白的作用。
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