尿肾损伤分子-1对肾移植患者长期移植肾功能的预测价值：一项前瞻性研究。
The predictive value of urinary kidney injury molecular-1 for long-term graft function in kidney transplant patients: a prospective study.
作者信息
Zhu Minyan, Chen Zhejun, Wei Yuehan, Yuan Yanhong, Ying Liang, Zhou Hang, Che Xiajing, Zhang Min Fang, Ni Zhaohui, Zhang Ming, Mou Shan
机构信息
Department of Nephrology, Molecular Cell Laboratory for Kidney Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transplantation Center of Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
Ann Transl Med. 2021 Feb;9(3):244. doi: 10.21037/atm-20-2215a.
BACKGROUND
Monitoring allograft function during the early stages is crucial, and therefore requires biomarkers more sensitive than serum creatinine (Scr). Kidney injury molecular-1 (KIM-1) is a potent biomarker; however, disparities exist in the literature concerning its predictive value in allograft function. Therefore, this study aimed to evaluate its predictive value for the long-term prognosis of kidney transplantation patients.
METHODS
A prospective study with a cohort comprising 160 patients scheduled for kidney transplantation was conducted to evaluate the predictive power of urinary KIM-1 (uKIM-1) and other renal ischemia-reperfusion biomarkers including urinary L-type fatty acid binding protein (uL-FABP), urinary N-acetyl-β-D glucosaminidase (uNAG), and urinary neutrophil gelatinase-related lipoprotein (uNGAL) for allograft prognosis.
RESULTS
One hundred and forty kidney recipients who were admitted to our hospital between September 2014 and December 2017 with a median follow-up of 30.3 months were included. Thirty-seven recipients had functional delayed graft function (fDGF) in the first week post transplantation, and 42 recipients had progressed to allograft dysfunction [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m] by the end of the study, while nine recipients deteriorated into allograft loss (defined by the initiation of dialysis). The levels of uKIM-1 in the fDGF group were higher than those in the immediate graft function (IGF) recipients (P<0.05) at 0 hour post transplantation [5.885 (4.420-7.913) 4.605 (3.417-5.653) ng/mmol], and on the first day post transplantation [5.569 (4.181-6.722) 4.002 (3.222-6.488) ng/mmol]. The levels of uL-FABP in the fDGF group were also higher than those in the IGF group at 0 hour post transplantation (89.818±39.332 69.187±37.926 µg/mmol) and on the third day post transplantation [77.835 (60.368-100.678) 66.841 (28.815-89.783) µg/mmol]. Multivariate Cox regression analysis demonstrated that recipients with higher uKIM-1 levels on the first day post transplantation had a 23.5% increase in the risk of developing fDGF and a 27.3% increase in the risk of prolonged renal allograft dysfunction.
CONCLUSIONS
uKIM-1 on the first day post transplantation can predict short-term graft function and is a potent biomarker for the long-term prognosis of graft function.
背景
在早期阶段监测同种异体移植肾功能至关重要，因此需要比血清肌酐（Scr）更敏感的生物标志物。肾损伤分子-1（KIM-1）是一种有效的生物标志物；然而，关于其在同种异体移植功能中的预测价值，文献中存在差异。因此，本研究旨在评估其对肾移植患者长期预后的预测价值。
方法
进行了一项前瞻性研究，队列包括160例计划进行肾移植的患者，以评估尿KIM-1（uKIM-1）和其他肾缺血再灌注生物标志物，包括尿L型脂肪酸结合蛋白（uL-FABP）、尿N-乙酰-β-D-氨基葡萄糖苷酶（uNAG）和尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）对同种异体移植预后的预测能力。
结果
纳入了2014年9月至2017年12月期间入住我院的140例肾移植受者，中位随访时间为30.3个月。37例受者在移植后第一周出现功能性延迟移植肾功能（fDGF），42例受者在研究结束时进展为同种异体移植功能障碍[估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²]，而9例受者恶化至同种异体移植丢失（定义为开始透析）。fDGF组在移植后0小时[5.885（4.420 - 7.913）对4.605（3.417 - 5.653）ng/mmol]和移植后第一天[5.569（4.181 - 6.722）对4.002（3.222 - 6.488）ng/mmol]时的uKIM-1水平高于即刻移植肾功能（IGF）受者（P<0.05）。fDGF组在移植后0小时（89.818±39.332对69.187±37.926 µg/mmol）和移植后第三天[77.835（60.368 - 100.678）对66.841（28.815 - 89.783）µg/mmol]时的uL-FABP水平也高于IGF组。多因素Cox回归分析表明，移植后第一天uKIM-1水平较高的受者发生fDGF的风险增加23.5%，肾同种异体移植功能延迟的风险增加27.3%。
结论
移植后第一天的uKIM-1可预测短期移植肾功能，是移植功能长期预后的有效生物标志物。
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