王平贤,方丽,黄秀英,王安静
WANG Ping-xian; FANG Li; HUANG Xiu-ying; WANG An-jing (Department of Urology Surgery;

• 1:中国人民解放军第三军医大学附属新桥医院泌尿外科
• 2:中国人民解放军第三军医大学附属新桥医院泌尿外科
• 3:中国人民解放军第三军医大学附属新桥医院泌尿外科
• 4:中国人民解放军第三军医大学附属新桥医院泌尿外科 重庆400037

摘要(Abstract)：

目的: 探讨早期检测肾移植患者尿转化生长因子β1 (TGF β1 )对远期慢性移植物肾病(CAN)有无预测作用。方法: 对144例肾移植时间达1年、肾功能正常的患者,检测尿TGF β1 浓度,然后将TGF β1 浓度最低和最高的各40例患者组建为组Ⅰ、组Ⅱ,对上述80例患者进行至少3年的前瞻性观察;比较2组在3年内肾功能的损失量和肾功能不良者的病例数有无差异;分析早期尿TGF β1 浓度与远期肾功能有无相关性;对肾功能不良者做移植肾穿剌活检,明确是否为CAN。结果: 组Ⅱ肌酐清除率(Ccr)进行性降低。3年后,组ⅡCcr损失量和肾功不良者的病例数分别为(14 4±10 3)ml/min和9例,显著大于组Ⅰ(P<0 01),后者分别为(6 8±5 7)ml/min和2例;术后达1年时的尿TGF β1 浓度与3年后的肾功能二者间有着显著的相关性(r=0 409,P<0 01);肾功能不良者,移植肾在组织学上均呈CAN的改变。结论: TGF β1 可能在CAN的发生中起着重要的作用,肾移植早期尿TGF β1 浓度对CNA具有预测作用,TGF β1 浓度高者远期肾功能差。
Objective: To determine whether urine TGF-β 1 concentration is predictive for chronic allograft nephropathy (CAN). Methods: Urine TGF-β 1 concentrations were tested for 144 recipients who had had renal transplantation for one year.Of them, 40 cases with lower urine TGF-β 1 concentrations formed groupⅠ, and other 40 cases with higher urine TGF-β 1 formed group Ⅱ.Three years later, renal function, blood and urine TGF-β 1 concentrations were compared between the two groups. The relation between urine TGF-β 1 and CAN was assessed. Biopsies were carried out in renal recipients whose creatinine was higher than normal. Results: 3 years later, group II had a loss of creatinine clearance (Ccr) of 14.4±10.3(ml/min) and 9 cases suffering from CAN. There was more loss of renal function and more number of CAN cases in group II than in group I (P<0.01). Urine TGF-β 1 concentration in group I grew more obviously. The differences in the two groups were significant. There was an association between urine TGF-β 1 and CAN(r=0.416, P<0.01). All biopsies showed the characters of CAN. Conclusions: The findings suggest that urine TGF-β 1 is significantly higher in patients with CAN. The level of urine TGF-β 1 in early stage after renal transplantation can predict future renal function.

关键词(KeyWords)： 肾移植;移植物;肾疾病;转化生长因子β
kidney transplantation; transplants; kidney diseases; transforming growth factor beta;

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 王平贤,方丽,黄秀英,王安静
WANG Ping-xian; FANG Li; HUANG Xiu-ying; WANG An-jing (Department of Urology Surgery;

DOI: 10.19367/j.cnki.1000-2707.2005.02.010

参考文献(References)：

• [1]WildemannB,LübberstedtM,HaasNP,etal.IGF IandTGF beta1incorporatedinapolyimplantcoatingmain taintheiractivityoverlong termstorage cellculturestud iesonprimaryhumanosteoblast-likecells[J].Biomaterials,2004,25(17):3639-3644.
• [2]IshimuraT,FujisawaM,HiguchiA,etal.Transforminggrowthfactor beta1 expressioninearlybiopsyspecimenpredictslong termgraftfunctionfollowingpediatricrenaltransplantation[J].ClinTransplant,2001,15(3):185-191.
• [3]PaulLC.Chronicallograftnephropathy:Anupdate[J].KidneyInt,1999,56(3):783-793.
• [4]AbdelWN,WestonBS,RobertsT,etal.Connectivetissuegrowthfactorandregulationofthemesangialcellcycle:roleincellularhypertrophy[J].JAmSocNephrol,2002,13(10):2437-2445.
• [5]DensemCG,MutlakASM,PravicaV,etal.Anovelpoly morphismofthegeneencodingfurin,aTGF β1 activator,andtheinfluenceoncardiacallograftvasculopathyforma tion[J].TransplantImmunology,2004,37(7):697-702.
• [6]郭兵,万昌武,桂华珍,等.糖尿病大鼠肾间质TGF β1和αSMA的表达与细胞外基质沉积的关系[J].贵阳医学院学报,2003,28(4):301-305.
• [7]CitterioF,PozzettoU,RomagnoliJ,etal.Plasmalevelsoftransforminggrowthfactorβ1 inrenaltransplantrecipientsreceivingdifferentimmunosuppressiveregimens[J].TransplantationProceedings,2004,36(3):698-699.
• [8]AmannK,KochAhofstetterJ.Glomerulosclerosisandpro gression:effectofsubantihypertensivedosesofalphaandbetablockers[J].KidneyInt,2001,60(4):1309-1323.
• [9]陈晓琴,周力,谭玉洁.尿NAG测定对诊断胰腺炎早期肾损害的意义[J].贵阳医学院学报,2002,27(1):47-49.
• [10]HoulihanCA,AkdenizA,TsalamandrisC,etal.Urinarytransforminggrowthfactor betaexcretioninpatientswithhypertension,type2diabetes,andelevatedalbuminex cretionrate:effectsofangiotensinreceptorblockadeandsodiumrestriction[J].DiabetesCare,2002,25(6):1072-1077.

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