Malyszko J, Przybylowski P, Malyszko J, Koc-Zorawska E, Mysliwiec M
Department of Nephrology and Transplantology, Medical University, Bialystok, Poland.
Transplant Proc. 2011 Jun;43(5):1877-80. doi: 10.1016/j.transproceed.2011.03.035.
Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) was originally identified as the third member of the TNF superfamily to induce apoptosis. TRAIL is normally expressed in many human tissues including kidney. Circulating soluble TRAIL is a negative marker for inflammation and is inversely associated with the mortality risk in chronic kidney disease patients. One increasingly prevalent complication in heart transplant recipients appears to be chronic kidney disease.
The aim of the study was to assess TRAIL concentration in 136 heart transplant recipients and 80 prevalent kidney allograft recipients in relation to kidney function. Complete blood count, urea, serum lipids, fasting glucose, creatinine, NT-proBNP were studied. Soluble TRAIL, hsCR P, interleukin-6 (IL-6), von willebrand factor (vWF) were assayed using commercially available kits.
Heart transplant recipients had significantly higher serum creatinine, urea, cholesterol, triglycerides, fasting glucose, white blood cell count, serum TRAIL and lower estimated glomerular filtration rate than the control group. Similar results were obtained for kidney allograft recipients. Serum TRAIL levels fell, together with decline in glomerular filtration rate in heart transplant patients. Serum TRAIL was related to age, kidney function, erythrocyte count, hemoglobin, NT-proBNP, New York Heart Association class, presence of diabetes, high-density lipoprotein (HDL), IL-6, and ejection fraction. Age and HDL turn out to be predictors of TRAIL in heart transplant recipients. In kidney transplant recipients, TRAIL was related, in univariate analysis, to age, NT-proBNP, time after transplantation, kidney function, and vWF. In multiple regression analysis, predictors of TRAIL were vWF and time after transplantation.
TRAIL may represent a surrogate marker of endothelial dysfunction and atherosclerosis as these processes are accelerated in heart and kidney dysfunction.
肿瘤坏死因子（TNF）相关凋亡诱导配体（TRAIL）最初被鉴定为TNF超家族中诱导凋亡的第三个成员。TRAIL通常在包括肾脏在内的许多人体组织中表达。循环中的可溶性TRAIL是炎症的阴性标志物，与慢性肾病患者的死亡风险呈负相关。心脏移植受者中一种日益普遍的并发症似乎是慢性肾病。
本研究的目的是评估136名心脏移植受者和80名肾移植受者中TRAIL浓度与肾功能的关系。研究了全血细胞计数、尿素、血脂、空腹血糖、肌酐、NT-proBNP。使用市售试剂盒检测可溶性TRAIL、超敏C反应蛋白（hsCRP）、白细胞介素-6（IL-6）、血管性血友病因子（vWF）。
心脏移植受者的血清肌酐、尿素、胆固醇、甘油三酯、空腹血糖、白细胞计数、血清TRAIL显著高于对照组，而估计肾小球滤过率较低。肾移植受者也得到了类似的结果。心脏移植患者血清TRAIL水平随肾小球滤过率下降而降低。血清TRAIL与年龄、肾功能、红细胞计数、血红蛋白、NT-proBNP、纽约心脏协会分级、糖尿病的存在、高密度脂蛋白（HDL）、IL-6和射血分数有关。年龄和HDL是心脏移植受者TRAIL的预测因子。在肾移植受者中，单因素分析显示TRAIL与年龄、NT-proBNP、移植后时间、肾功能和vWF有关。多因素回归分析显示，TRAIL的预测因子是vWF和移植后时间。
由于内皮功能障碍和动脉粥样硬化在心脏和肾功能障碍中加速，TRAIL可能代表这些过程的替代标志物。
