Sárváry E, Borka P, Sulyok B, Péter A, Vass Z, Rákóczy G, Selmeci L, Takács L, Járay J, Perner F
Transplantation and Surgical Clinic, Semmelweis Medical University, Budapest, Hungary.
Transpl Int. 1996;9 Suppl 1:S68-72. doi: 10.1007/978-3-662-00818-8_18.
The measurement of enzyme activity in urine provides a sensitive assessment for renal tubular cell damage. The present study was undertaken to evaluate the clinical value of the determination of tubular brush-border-associated enzymes, alkaline phosphatase (AP), gamma-glutamyl transferase (GGT), leucine aminopeptidase (LAP), and dipeptidyl peptidase IV (DPP), of patients with normal graft function (NOR, n = 20), with acute tubular necrosis (ATN, n = 11), with an acute rejection episode (ARE, n = 17) after transplantation, and of healthy persons (n = 20). The second urine of the morning was collected daily during the patients' stay in hospital. The enzyme activities were measured at 25 degrees C and were expressed as U/mmol creatinine. The enzymuria in NOR is higher than in healthy controls, but is still in the normal range. By 5 days after transplantation the initial increased excretion declines as the graft function improves. Elevated enzymuria (DPP 0.69 +/- 0.56, AP 3.06 +/- 3.24, GGT 4.16 +/- 4.13, and LAP 1.39 +/- 1.27) was observed during the rejection episodes. Two days before clinical diagnosis of rejection, the release of DPP-IV and GGT increases to double, and the AP and LAP increases to 3 times the value on the fourth day before rejection. Successful treatment of rejection coincided with a quick return by the third day of the rejection period to the previous enzyme distribution. In ATN no decrease of enzymuria occurs and the excretion is much higher than in ARE. Our method with the every day monitoring of kidney graft function offers the possibility for the early diagnosis of acute rejection.
尿液中酶活性的测定为肾小管细胞损伤提供了一种灵敏的评估方法。本研究旨在评估测定肾小管刷状缘相关酶，即碱性磷酸酶（AP）、γ-谷氨酰转移酶（GGT）、亮氨酸氨肽酶（LAP）和二肽基肽酶IV（DPP），对于移植肾功能正常者（NOR，n = 20）、急性肾小管坏死患者（ATN，n = 11）、移植后发生急性排斥反应者（ARE，n = 17）以及健康人（n = 20）的临床价值。患者住院期间每天收集晨尿。酶活性在25℃下测定，并以U/mmol肌酐表示。NOR组的酶尿高于健康对照组，但仍在正常范围内。移植后5天，随着移植肾功能改善，最初增加的排泄量下降。在排斥反应期间观察到酶尿升高（DPP 0.69±0.56，AP 3.06±3.24，GGT 4.16±4.13，LAP 1.39±1.27）。在临床诊断排斥反应前两天，DPP-IV和GGT的释放量增加至两倍，AP和LAP增加至排斥反应前第四天值的3倍。成功治疗排斥反应与排斥期第三天迅速恢复到先前的酶分布情况相吻合。在ATN患者中，酶尿没有下降，且排泄量远高于ARE患者。我们这种每天监测肾移植功能的方法为急性排斥反应的早期诊断提供了可能性。
