Detection of Clinical and Subclinical Tubulo-Interstitial Inflammation by the Urinary CXCL10 Chemokine in a Real-Life Setting
Detection of Clinical and Subclinical Tubulo-Interstitial Inflammation by the Urinary CXCL10 Chemokine in a Real-Life Setting
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DOI：
10.1111/j.1600-6143.2012.03999.x
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发表时间：
2012-07-01
影响因子：
8.8
通讯作者：
Schaub, S.
中科院分区：
文献类型：
--
作者：
Hirt-Minkowski, P.;Amico, P.;Schaub, S.
尿液 CXCL10 是一种很有前景的肾小管间质同种异体移植炎症的非侵入性生物标志物，但其诊断特征尚未在现实生活中进行评估。我们研究了 213 名连续肾同种异体移植受者的尿液 CXCL10，在 3/6 个月时进行了 362 次监测活检，并在移植后第一年内进行了 80 次适应症活检。同种异体移植物组织学结果分类为（i）急性班夫评分为零，（ii）仅间质浸润，（iii）t1小管炎，（iv）t23小管炎和（v）孤立性血管室炎症。对于临床和亚临床病理，尿液 CXCL10 与肾小管间质炎症的程度密切相关。为了确定尿液 CXCL10 的诊断特征，将组织学组分为两类：无相关炎症（即急性班夫评分为零和仅间质浸润）与所有其他病理（即小管炎 t13 和孤立性血管室炎症）。对于亚临床病理，AUC 为 0.69（敏感性 61%，特异性 72%）；对于临床病理学，AUC 为 0.74（敏感性 63%，特异性 80%）。 CXCL10 引导的尿液活检策略会使监测和指示活检的性能分别降低 61% 和 64%。漏诊的（亚）临床病理大多为 t1 型肾小管炎和孤立性血管室病变。在现实生活中，尿液 CXCL10 具有临床上有用的诊断特性，使其成为指导同种异体移植物活检的候选生物标志物。
Urinary CXCL10 is a promising noninvasive biomarker for tubulo-interstitial allograft inflammation, but its diagnostic characteristics have not been assessed in a real-life setting. We investigated urinary CXCL10 in 213 consecutive renal allograft recipients having 362 surveillance biopsies at 3/6 months and 80 indication biopsies within the first year posttransplant. Allograft histology results were classified as (i) acute Banff score zero, (ii) interstitial infiltrates only, (iii) tubulitis t1, (iv) tubulitis t23 and (v) isolated vascular compartment inflammation. For clinical and subclinical pathologies, urinary CXCL10 correlated well with the extent of tubulo-interstitial inflammation. To determine diagnostic characteristics of urinary CXCL10, histological groups were separated into two categories: no relevant inflammation (i.e. acute Banff score zero and interstitial infiltrates only) versus all other pathologies (i.e. tubulitis t13 and isolated vascular compartment inflammation). For subclinical pathologies, AUC was 0.69 (sensitivity 61%, specificity 72%); for clinical pathologies, AUC was 0.74 (sensitivity 63%, specificity 80%). A urinary CXCL10-guided biopsy strategy would have reduced performance of surveillance and indication biopsies by 61% and 64%, respectively. Missed (sub)clinical pathologies were mostly tubulitis t1 and isolated vascular compartment lesions. In real life, urinary CXCL10 had clinically useful diagnostic properties making it a candidate biomarker to guide allograft biopsies.