Müller T F, Neumann C M, Greb C, Kraus M, Lange H
Department of Nephrology/Centre of Internal Medicine, Philipps-University of Marburg, Germany.
Transpl Int. 1996;9 Suppl 1:S58-62. doi: 10.1007/978-3-662-00818-8_16.
In the underlying study the diagnostic value of the anaphylatoxin C5a was evaluated in kidney transplantation. In 49 transplant patients the following parameters were measured daily for a mean period of 25.1 days: plasma C5a [P-C5a], urine C5a [U-C5a], serum amyloid A [SAA], serum neopterin [S-NEOP] and urine neopterin [U-NEOP]. Sensitivity, specificity and day of first significant parameter increase (exceeding a cut-off level of > 50%) were evaluated retrospectively during 30 periods of rejection and 30 periods of stable graft function. U-C5a was the parameter with the highest sensitivity (84%) and specificity (84%), increasing in the mean 1.3 days before clinical diagnosis of rejection. Sensitivity and specificity of the other markers was lower: SAA 77% and 77%, U-NEOP 68% and 65%, S-NEOP 45% and 77%, and P-C5a 45% and 48%, respectively. During four instances of cytomegalovirus disease extremely high U-NEOP (> or = 1520 +/- 518 mumol/mol creatinine) and slightly increased P-C5a levels (> or = 1.5 +/- 1.4 ng/ml) occurred. Elevated urinary excretion of C5a seems to be a reliable and early marker of renal allograft rejection. In combination with SAA and U-NEOP, the daily assessment of U-C5a differentiates between viral infection and allograft rejection.
在一项基础研究中，评估了过敏毒素C5a在肾移植中的诊断价值。对49例移植患者平均25.1天每日测量以下参数：血浆C5a [P-C5a]、尿C5a [U-C5a]、血清淀粉样蛋白A [SAA]、血清新蝶呤 [S-NEOP] 和尿新蝶呤 [U-NEOP]。在30个排斥期和30个移植肾功能稳定期回顾性评估敏感性、特异性以及首个显著参数升高的日期（超过50% 的临界值）。U-C5a是敏感性（84%）和特异性（84%）最高的参数，在排斥临床诊断前平均1.3天升高。其他标志物的敏感性和特异性较低：SAA分别为77% 和77%，U-NEOP分别为68% 和65%，S-NEOP分别为45% 和77%，P-C5a分别为45% 和48%。在4例巨细胞病毒病中，出现了极高的U-NEOP（≥1520±518 μmol/mol肌酐）和P-C5a水平略有升高（≥1.5±1.4 ng/ml）。C5a尿排泄升高似乎是肾移植排斥的可靠早期标志物。结合SAA和U-NEOP，每日评估U-C5a可区分病毒感染和移植排斥。
