Santos C, Marcelino P, Carvalho T, Coelho J, Bispo M, Mourão L, Perdigoto R, Barroso E
Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal.
Transplant Proc. 2010 Nov;42(9):3639-43. doi: 10.1016/j.transproceed.2010.06.024.
Tubular enzymes (TE) are early markers of acute kidney injury (AKI), but their value for liver transplant (LT) recipients is unknown. We sought to evaluate the usefulness of TE to predict AKI after LT. We enrolled Thirty-nine adult patients without AKI who had been admitted to the Intensive Care Unit (ICU). AKI was diagnosed according to the Acute Kidney Injury Network criteria. Of these patients, 23 had received orthotopic LT and 16 controls had been admitted for other conditions. Urinary lactate dehydrogenase (LDH), alkaline phosphatase (AF) and γ-glutamyl transpeptidase (γ-GT) measured on days 1 and 3 of the ICU stay were normalized to urinary creatinine concentrations. AKI was diagnosed in 14 patients: 8 in the LT group and 6 in the control group. In the LT group, on the first day of the patients' stay in the ICU, urinary LDH (P = .032), AF (P = .022), and γ-GT (P = .002) were significantly higher among those who developed AKI; these elevations preceded those of serum creatinine. In forward receiver-operating characteristic (ROC) plot analysis, the areas under the ROC curves were 0.8, 0.86, and 0.92 for LDH, AF, and γ-GT, respectively. We concluded that TE determined early after LT are a helpful predictors of AKI.
肾小管酶（TE）是急性肾损伤（AKI）的早期标志物，但其对肝移植（LT）受者的价值尚不清楚。我们试图评估TE对预测LT术后AKI的有用性。我们纳入了39名入住重症监护病房（ICU）且无AKI的成年患者。根据急性肾损伤网络标准诊断AKI。在这些患者中，23例接受了原位肝移植，16例因其他疾病入院作为对照。在ICU住院第1天和第3天测量的尿乳酸脱氢酶（LDH）、碱性磷酸酶（AF）和γ-谷氨酰转肽酶（γ-GT）均根据尿肌酐浓度进行了标准化。14例患者被诊断为AKI：肝移植组8例，对照组6例。在肝移植组中，患者入住ICU的第一天，发生AKI者的尿LDH（P = 0.032）、AF（P = 0.022）和γ-GT（P = 0.002）显著更高；这些升高早于血清肌酐升高。在前瞻性受试者工作特征（ROC）曲线分析中，LDH、AF和γ-GT的ROC曲线下面积分别为0.8、0.86和0.92。我们得出结论，肝移植后早期测定的TE是AKI的有用预测指标。
