在一组接受肾移植的患者中，新型移植物结局标志物：一项队列观察性研究。
Novel markers of graft outcome in a cohort of kidney transplanted patients: a cohort observational study.
机构信息
Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Via Commenda 15, 20122, Milan, Italy.
Research Laboratory of Nephrology, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
出版信息
J Nephrol. 2019 Feb;32(1):139-150. doi: 10.1007/s40620-018-00580-0. Epub 2019 Jan 10.
Renal biopsy (RBx) informs about kidney transplantation (KTx) prognosis. In our observational study the prevalence of histological anomalies and the prognostic role of CD45, vimentin (VIM) and periostin (POSTN) in KTx-RBx have been evaluated. One hundred forty-six KTx-RBx (2009-2012) were analysed for general histology and in immunohistochemistry for CD45, VIM and POSTN. Clinical data of the 146-KTx patients were collected at the RBx time (T0), 6 and 12 months before and after RBx. Follow-up time was 21 ± 14 months. Glomerulosclerosis was 20% glomeruli/biopsy. Tubular atrophy (TA), Interstitial infiltrate (I-Inf) and interstitial fibrosis (IF) were slight in 21-18% and 25%, moderate in 22-30% and 26% and severe in 30-18% and 28% of patients. Fifty-eight percent of patients had lesions compatible with IF-TA. CD45, VIM and POSTN correlated to each-other and to TA, I-Inf and IF. VIM and POSTN correlated to GS. CD45 and VIM correlated directly to renal function (RF) and 25(OH)VitD, while POSTN inversely to 25(OH)VitD. Thirty patients restarted dialysis (HD+). HD+ had lower T0-eGFR, and higher CD45, VIM and POSTN than HD-. POSTN resulted the strongest in discriminate for HD+ . CD45, VIM and POSTN correlate to each-other and predict graft outcome. POSTN was the strongest in discriminate for HD+. 25(OH)VitD might influence inflammation and fibrosis in KTx.
肾活检（RBx）可提供有关肾移植（KTx）预后的信息。在我们的观察性研究中，评估了 KTx-RBx 中组织学异常的患病率以及 CD45、波形蛋白（VIM）和骨桥蛋白（POSTN）的预后作用。分析了 146 例 KTx-RBx（2009-2012 年）的一般组织学，并进行了 CD45、VIM 和 POSTN 的免疫组织化学分析。在 RBx 时（T0）、RBx 前 6 个月和 12 个月以及 RBx 后 6 个月和 12 个月收集了 146 例 KTx 患者的临床数据。随访时间为 21±14 个月。肾小球硬化为 20%肾小球/活检。肾小管萎缩（TA）、间质浸润（I-Inf）和间质纤维化（IF）在 21-18%和 25%、22-30%和 26%、30-18%和 28%的患者中为轻度、中度和重度。58%的患者存在与 IF-TA 相符的病变。CD45、VIM 和 POSTN 彼此相关，与 TA、I-Inf 和 IF 相关。VIM 和 POSTN 与 GS 相关。CD45 和 VIM 与肾功能（RF）和 25（OH）VitD 直接相关，而 POSTN 与 25（OH）VitD 相反。30 例患者开始接受血液透析（HD+）。HD+的 T0-eGFR 较低，CD45、VIM 和 POSTN 较高，而 25（OH）VitD 较低。POSTN 是区分 HD+的最强因素。CD45、VIM 和 POSTN 相互关联并预测移植物结局。POSTN 是区分 HD+的最强因素。25（OH）VitD 可能影响 KTx 中的炎症和纤维化。
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