肾移植受者血清同型半胱氨酸水平的变化

摘要

Objective To observe the changes of serum homocysteine (Hcy)level of renal transplant recipients before and after renal transplantation,and assess the correlation between serum Hcy level and graft function.Methods Thirty-three recipients were included into the transplantation group,who underwent renal allograft transplantation in the Organ Transplant Institute of the 309 th Hospital of People's Liberation Army and had renal function recovered stably from January 2013 to June 2014.And 65 patients who were confirmed as chronic renal failure (CRF)by clinical examinations were included into the CRF group and 30 healthy people were included into the control group.A retrospective cross-sectional study was conducted on all of these subjects.Serum Hcy,serum creatinine (Scr)and blood urea nitrogen (BUN)levels of these three groups were compared.Serum Hcy and Scr levels of the transplantation group were continuously monitored before transplantation and at 3,7,14 and 21d after transplantation.The correlation between the changes of serum Hcy levels and the renal function before and after transplantation was assessed.Results Serum Hcy level of the CRF group was (25 ±10)μmol/L,which was significantly higher than (9 ±4)μmol/L of the control group and (15 ±9)μmol/L of the transplantation group in stable period,with statistical significance (all in P <0.001).Serum Hcy level of the transplantation group was significantly higher than that of the control group(P <0.001).Scr level of the CRF group,the transplantation group and the control group was(708 ±302)μmol/L, (98 ±23)μmol/L and (72 ±18)μmol/L,respectively.Scr level of the CRF group was significantly higher than those of the transplantation group and the control group (all in P <0.001).BUN level of the CRF group, the transplantation group and the control group was (18.1 ±5.9)mmol/L,(10.9 ±5.3)mmol/L and (4.9 ± 1.3) mmol/L, respectively. BUN level of the CRF group was significantly higher than that of the transplantation group and the control group (all in P <0.001),and BUN level of the transplantation group was significantly higher than that of the control group (P <0.001).With the improvement in renal function after transplantation,Scr and serum Hcy levels of the transplantation group deceased gradually.At 14 d after transplantation,Hcy level decreased to the minimum of (15 ±5)μmol/L.Compared with (25 ±10)μmol/L before transplantation,the difference had statistical significance (P <0.05).Within 14 d after transplantation, serum Hcy level of the transplantation group was positively correlated with Scr level (r =0.761,P <0.05). Conclusions Serum Hcy level of the renal transplant recipients is correlated with the graft function.The combined detection of serum Hcy and renal function index has certain guiding significance in the prevention of hyperhomocysteinemia and the early assessment of graft function.%目的：观察肾移植受者移植前后血清同型半胱氨酸（Hcy）水平的变化，评估其与移植物功能之间的关系。方法横断面回顾性研究选择2013年1月至2014年6月间在解放军第309医院全军器官移植研究所接受首次同种异体肾移植手术且肾功能恢复稳定33例受者为移植组，经临床检查确诊为慢性肾衰竭（CRF）的患者65例为 CRF 组，30名健康体检人员作为对照组。比较各组血清 Hcy、血清肌酐（Scr）和血尿素氮（BUN）水平。连续监测移植组在肾移植术前及术后3、7、14、21 d 的血清 Hcy 和 Scr 水平，比较肾移植前后血清 Hcy 水平的变化与肾功能之间的关系。结果 CRF组患者的血清 Hcy 水平为（25±10）μmol／L，明显高于对照组的（9±4）μmol／L 和移植组稳定期的（15±9）μmol／L，移植组的血清 Hcy 水平亦明显高于对照组，差异均有统计学意义（均为P ＜0.001）。CRF 组、移植组和对照组的 Scr 水平分别为（708±302）μmol／L、（98±23）μmol／L、（72±18）μmol／L，CRF 组的 Scr 水平明显高于移植组和对照组，差异均有统计学意义（均为P ＜0.001）。CRF 组、移植组和对照组的 BUN 水平分别为（18.1±5.9）mmol／L、（10.9±5.3）mmol／L、（4.9±1.3）mmol／L，CRF 组的 BUN 水平明显高于移植组和对照组，差异均有统计学意义（均为 P ＜0.001），移植组 BUN 水平亦高于对照组，差异有统计学意义（P ＜0.001）。移植组患者肾移植术后随着肾功能好转，Scr 和血清 Hcy 水平逐渐降低，其中术后14 d 血清 Hcy 水平降至最低（15±5）μmol／L，与术前的（25±10）μmol／L 相比，差异有统计学意义（P ＜0.05）。术后14 d 内，移植组肾移植受者的血清 Hcy 水平与 Scr 水平呈正相关（r ＝0.761，P ＜0.05）。结论肾移植受者的血清 Hcy 水平与移植肾功能相关，联合检测血清 Hcy 与肾功能指标对预防高 Hcy 血症和早期评估移植物功能有一定指导意义。