C 反应蛋白和尿蛋白排泄对血清白蛋白预测肾移植受者移植物失败和死亡率的影响。

Influence of C-reactive protein and urinary protein excretion on prediction of graft failure and mortality by serum albumin in renal transplant recipients.

机构信息

University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.

出版信息

Transplantation. 2010 May 27;89(10):1247-54. doi: 10.1097/TP.0b013e3181d720e3.

DOI:10.1097/TP.0b013e3181d720e3

PMID:20559032

Abstract

BACKGROUND

Hypoalbuminemia is an established predictor of poor outcome in renal transplant recipients (RTR). It is considered to reflect inflammation, poor nutritional status, or proteinuria. We explored the roles of high-sensitivity C-reactive protein (hsCRP) and urinary protein excretion in prediction of graft failure and mortality by serum albumin in RTR.

METHODS

We included 605 RTR at a median (interquartile range) time of 6.0 years (2.5-11.5 years) after transplantation for baseline measurements.

RESULTS

At baseline, urinary protein excretion (beta=-0.242, P<0.0001), hsCRP concentration (beta=-0.207, P<0.0001), recipient age (beta=-0.115, P=0.004), living kidney donor (beta=0.100, P=0.01), and a history of myocardial infarction (beta=-0.084, P=0.03) were independently related to serum albumin. Prospectively, 94 RTR died and 42 had graft failure during 5.3 years (4.7-5.7 years) of follow-up. After adjustment for potential confounders, including hsCRP and urinary protein excretion in Cox-regression analyses, low serum albumin was significantly associated with graft failure (hazard ratio=0.34 [95% confidence interval=0.15-0.76] per g/dL, P=0.008) and mortality (hazard ratio=0.43 [95% confidence interval=0.24-0.78] per g/dL, P=0.005), with significant modification of the effect of serum albumin on graft failure by urinary protein excretion (P=0.003).

CONCLUSION

Low serum albumin concentrations predict graft failure and mortality in RTR independent of hsCRP and urinary protein excretion. The effect of serum albumin on graft failure is strongly modified by urinary protein excretion. These results suggest that chronic low-grade inflammation is not an important mechanism underlying inverse associations of serum albumin with graft failure and mortality. They also suggest that proteinuria is involved in the association of low serum albumin with graft failure.

摘要

背景

低白蛋白血症是肾移植受者（RTR）预后不良的既定预测因子。它被认为反映了炎症、营养状况差或蛋白尿。我们探讨了 hsCRP 和尿蛋白排泄在 RTR 中通过血清白蛋白预测移植物失功和死亡率的作用。

方法

我们纳入了 605 例 RTR，中位（四分位距）时间为移植后 6.0 年（2.5-11.5 年），进行基线测量。

结果

基线时，尿蛋白排泄（β=-0.242，P<0.0001）、hsCRP 浓度（β=-0.207，P<0.0001）、受者年龄（β=-0.115，P=0.004）、活体供肾（β=0.100，P=0.01）和心肌梗死史（β=-0.084，P=0.03）与血清白蛋白独立相关。前瞻性随访 5.3 年（4.7-5.7 年）期间，94 例 RTR 死亡，42 例发生移植物失功。在 Cox 回归分析中调整潜在混杂因素，包括 hsCRP 和尿蛋白排泄后，低血清白蛋白与移植物失功显著相关（风险比=0.34 [95%置信区间=0.15-0.76]/g/dL，P=0.008）和死亡率（风险比=0.43 [95%置信区间=0.24-0.78]/g/dL，P=0.005），血清白蛋白对移植物失功的影响受尿蛋白排泄显著修饰（P=0.003）。