血浆中性粒细胞明胶酶相关脂质运载蛋白与接受标准或降低钙调神经磷酸酶抑制剂水平治疗的心脏移植受者的肾小球滤过率。
Plasma NGAL and glomerular filtration rate in cardiac transplant recipients treated with standard or reduced calcineurin inhibitor levels.
机构信息
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
出版信息
Biomark Med. 2014;8(2):239-45. doi: 10.2217/bmm.13.95.
AIM
Predictors of renal recovery following conversion from calcineurin inhibitor- to proliferation signal inhibitor-based therapy are lacking. We hypothesized that plasma NGAL (P-NGAL) could predict improvement in glomerular filtration rate (GFR) after conversion to everolimus.
PATIENTS & METHODS: P-NGAL was measured in 88 cardiac transplantation patients (median 5 years post-transplant) with renal dysfunction randomized to continuation of conventional calcineurin inhibitor-based immunosuppression or switching to an everolimus-based regimen.
RESULTS
P-NGAL correlated with measured GFR (mGFR) at baseline (R(2) = 0.21; p < 0.001). Randomization to everolimus improved mGFR after 1 year (median [25-75 % percentiles]: ΔmGFR 5.5 [-0.5-11.5] vs -1 [-7-4] ml/min/1.73 m(2); p = 0.006). Baseline P-NGAL predicted mGFR after 1 year (R(2) = 0.18; p < 0.001), but this association disappeared after controlling for baseline mGFR.
CONCLUSION
P-NGAL and GFR correlate with renal dysfunction in long-term heart transplantation recipients. P-NGAL did not predict improvement of renal function after conversion to everolimus-based immunosuppression.
目的
缺乏钙调磷酸酶抑制剂向增殖信号抑制剂转换后肾功能恢复的预测因子。我们假设血浆中性粒细胞明胶酶相关脂质运载蛋白（P-NGAL）可以预测依维莫司转换后肾小球滤过率（GFR）的改善。
患者和方法
88 例心脏移植后肾功能障碍的患者（移植后中位数 5 年）接受了血浆 NGAL（P-NGAL）的测量，这些患者被随机分配继续接受常规钙调磷酸酶抑制剂为基础的免疫抑制治疗或转换为依维莫司为基础的方案。
结果
P-NGAL 与基线时的实测肾小球滤过率（mGFR）相关（R²=0.21；p＜0.001）。依维莫司治疗组在 1 年后 mGFR 改善（中位数[25-75%分位数]：ΔmGFR 5.5[0.5-11.5] vs -1[-7-4]ml/min/1.73m²；p=0.006）。基线 P-NGAL 预测 1 年后 mGFR（R²=0.18；p＜0.001），但在控制基线 mGFR 后，这种相关性消失。
结论
P-NGAL 和 GFR 与长期心脏移植受者的肾功能障碍相关。P-NGAL 不能预测转换为依维莫司为基础的免疫抑制后肾功能的改善。
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