Time course of low molecular weight proteins in the early kidney transplantation period -: influence of corticosteroids
Time course of low molecular weight proteins in the early kidney transplantation period -: influence of corticosteroids
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DOI：
10.1093/ndt/gfh341
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发表时间：
2004-11-01
影响因子：
6.1
通讯作者：
Woitas, RP
中科院分区：
文献类型：
--
作者：
Pöge, U;Gerhardt, T;Woitas, RP
背景资料。半胱氨酸氨基转移酶C(CysC)是各种肾脏疾病患者和肾移植患者肾功能的新标志物。然而，关于移植后早期的数据很少。对22例肾移植(RTX)患者在0~14天的Cys C动态变化与肌酐和β2微球蛋白(B2 MG)的关系进行了研究。在移植前和移植后立即采集血样，此后每天采集血样。根据移植前血清水平(100%)计算减分率。分析物的减少有很大不同：在RTX后立即CysC下降了27.3%(P<；0.01)。然而，平均3天后，所有患者的Cys C水平均显著升高(15+/-2.5%；P<；0.01)。B2MG在服药后第1天和第7天分别迅速下降55.4%和73.8%，此后保持稳定。相比之下，肌酐在RTX后并没有立即下降，而是在研究结束时缓慢下降了67.5%。在被排斥之前，所有的分析物都表现出类似的行为。大剂量甲基强的松龙治疗后CysC显著升高(+22.8+/-7.9%，P<；0.05)，而肌酐和B2MG同时下降(-12.9+/-3.4%和-8.4+/-6.89%)。皮质类固醇治疗诱导免疫抑制或排斥治疗显著诱导Cys C，但减少B2MG。Cys-C和B2MG对早期诊断排斥反应无帮助。因此，我们的数据表明，CysC和B2MG检测不能准确反映移植后早期肾小球滤过率的变化。
Background. Cystatin C (Cys C) is an established new marker of renal function in patients with various renal diseases and in kidney transplantation. However, few data are available for the early post-transplantation period.Methods. Twenty-two patients who underwent renal transplantation (RTx) were evaluated for the kinetics of Cys C from day 0 to 14 in relation to creatinine and beta-2 microglobulin (B2MG). Blood samples were obtained immediately before and after transplantation and on a daily basis thereafter. Serum levels before transplantation (100%) were used to calculate reduction ratios.Results. The decrease of the analytes differed considerably: immediately after RTx Cys C declined by 27.3% (P < 0.01). However, after 3 days, on average, all patients showed a significant increase in Cys C levels (15 +/- 2.5%; P < 0.01). B2MG levels fell quickly by 55.4 and 73.8% after days 1 and 7, respectively, and remained stable thereafter. In contrast, creatinine did not decease immediately after RTx but fell slowly by 67.5% at the end of the study. Prior to rejection, all analytes showed a similar behaviour. Rejection treatment with high-dose methylprednisolone induced a significant increase in Cys C (+22.8 +/- 7.9%, P < 0.05), while in parallel, creatinine and B2MG decreased (-12.9 +/- 3.4 and -8.4 +/- 6.89%).Conclusions. Corticosteroid treatment for induction of immunosuppression or rejection therapy significantly induces Cys C, but decreases B2MG. Cys C and B2MG are not helpful in establishing the diagnosis of rejection earlier. Thus, our data indicate that Cys C and B2MG testing does not accurately reflect changes in the glomerular filtration rate early after transplantation.