Pacheco-Silva A, Nishida S K, Silva M S, Ramos O L, Azjen H, Pereira A B
Departamento de Medicina, da Escola Paulista de Medicina, São Paulo.
Rev Assoc Med Bras (1992). 1994 Jul-Sep;40(3):172-8.
Although there was an important improvement in graft and patient survival the last 10 years, graft rejection continues to be a major barrier to the success of renal transplantation. Identification of a laboratory test that could help to diagnose graft rejection would facilitate the management of renal transplanted patients. PURPOSE--To evaluate the utility of monitoring serum beta 2M in recently transplanted patients. METHODS--We daily determined serum beta 2M levels in 20 receptors of renal grafts (10 from living related and 10 from cadaveric donors) and compared them to their clinical and laboratory evolution. RESULTS--Eight patients who presented immediate good renal function following grafting and did not have rejection had a mean serum beta 2M of 3.7 mg/L on the 4th day post transplant. The sensitivity of the test for the diagnosis of acute rejection was 87.5%, but the specificity was only 46%. Patients who presented acute tubular necrosis (ATN) without rejection had a progressive decrease in their serum levels of beta 2M, while their serum creatinine changed as they were dialyzed. In contrast, patients with ATN and concomitance of acute rejection or CSA nephrotoxicity presented elevated beta 2M and creatinine serum levels. CONCLUSION--Daily monitoring of serum beta 2M does not improve the ability to diagnose acute rejection in patients with good renal function. However, serum beta 2M levels seemed to be useful in diagnosing acute rejection or CSA nephrotoxicity in patients with ATN.
尽管在过去10年里移植物和患者的存活率有了显著提高，但移植物排斥仍然是肾移植成功的主要障碍。找到一种有助于诊断移植物排斥的实验室检测方法将有助于对肾移植患者的管理。目的——评估监测近期移植患者血清β2微球蛋白（beta 2M）的效用。方法——我们每天测定20例肾移植受体（10例来自活体亲属供体，10例来自尸体供体）的血清beta 2M水平，并将其与临床和实验室检查结果进行比较。结果——8例移植后肾功能立即良好且未发生排斥反应的患者，移植后第4天血清beta 2M的平均水平为3.7mg/L。该检测对急性排斥反应诊断的敏感性为87.5%，但特异性仅为46%。发生急性肾小管坏死（ATN）但无排斥反应的患者血清beta 2M水平逐渐下降，而其血清肌酐水平在透析过程中发生变化。相比之下，合并急性排斥反应或环孢素A（CSA）肾毒性的ATN患者血清beta 2M和肌酐水平升高。结论——对肾功能良好的患者每日监测血清beta 2M并不能提高诊断急性排斥反应的能力。然而，血清beta 2M水平似乎有助于诊断ATN患者的急性排斥反应或CSA肾毒性。
