Correlations of serum Apelin-13 and Omentin-1 expression with renal function in patients after renal transplantation
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摘要:目的
探讨血清Apelin-13、网膜素-1(Omentin-1)在早期预测肾移植术后并发急性肾功能损伤中的价值。
方法纳入89例肾移植患者为肾移植组，根据肾移植术后1个月内患者是否发生急性肾功能损伤分为肾功能损伤组21例和非肾功能损伤组68例。同时随机选取健康体检者87例作为对照组。采用酶联免疫吸附(ELISA)法检测血清Apelin-13、Omentin-1水平; 采用粒子增强透射免疫比浊法测定胱抑素C水平; 采用酶法测定血肌酐水平; 采用紫外-谷氨酸脱氨酶法测定血尿素氮水平; 采用比浊法测定β2-微球蛋白、24 h尿蛋白水平。校正eMDRD方程，计算估算肾小球滤过率(eGFR)。采用Pearson法进行术后肾功能损伤的肾移植患者血清Apelin-13、Omentin-1水平与肾功能指标的相关性分析; 采用受试者工作特征(ROC)曲线分析血清Apelin-13、Omentin-1水平对肾移植患者术后肾功能损伤的预测价值; 采用Logistic回归分析法分析肾移植患者术后肾功能损伤的影响因素。
结果肾移植组的血肌酐、血尿素氮、胱抑素C、β2-微球蛋白、24 h尿蛋白水平高于对照组, Apelin-13、Omentin-1、eGFR水平低于对照组，差异有统计学意义(P < 0.05)。肾功能损伤组的血肌酐、血尿素氮、胱抑素C、β2-微球蛋白、24 h尿蛋白水平高于非肾功能损伤组, Apelin-13、Omentin-1、eGFR水平低于非肾功能损伤组，差异有统计学意义(P < 0.05)。术后肾功能损伤的肾移植患者血清Apelin-13、Omentin-1水平与肌酐、血尿素氮、胱抑素C、β2-微球蛋白、24 h尿蛋白呈负相关，与eGFR呈正相关(P < 0.05)。Apelin-13、Omentin-1单独及联合预测肾移植患者术后肾功能损伤的曲线下面积(AUC)分别为0.784、0.773、0.841。Apelin-13、Omentin-1是肾移植患者术后肾功能损伤的保护因素(P < 0.05)。
结论肾移植术后发生肾功能损伤患者血清中Apelin-13、Omentin-1均呈低表达，其或可成为早期预测指标。
Abstract:ObjectiveTo investigate the value of serum Apelin-13 and Omentin-1 in early prediction of acute renal injury after renal transplantation.
MethodsA total of 89 renal transplantation patients were included in the renal transplantation group, and were divided into renal injury group (21 cases) and non-renal injury group (68 cases) according to whether acute renal injury occurred within one month after renal transplantation. At the same time, 87 healthy people were randomly selected as the control group. Serum Apelin-13 and Omentin-1 levels were detected by enzyme-linked immunosorbent assay (ELISA); the Cystatin C levels were determined by particle enhanced transmission immunoturbidimetry; serum creatinine level was determined by enzyme method; the blood urea nitrogen level was determined by UV-glutamate deaminase method; the levels of β2-microglobulin and 24 h urinary protein were measured by turbidimetry. The eMDRD equations were corrected and estimated glomerular filtration rate (eGFR) was calculated. Pearson method was used to analyze the correlations of serum Apelin-13 and Omentin-1 levels with renal function indexes in renal transplantation patients with postoperative renal function injury; receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum Apelin-13 and Omentin-1 levels on postoperative renal function injury in renal transplantation patients; Logistic regression analysis was used to analyze the influencing factors of renal function injury after renal transplantation.
ResultsThe levels of serum creatinine, blood urea nitrogen, cystatin C, β2-microglobulin and 24 h urinary protein in the renal transplantation group were significantly higher, and the levels of Apelin-13, Omentin-1 and eGFR were significantly lower than those in the control group (P < 0.05). The levels of serum creatinine, blood urea nitrogen, cystatin C, β2-microglobulin and 24 h urinary protein in the renal injury group were significantly higher, and the levels of Apelin-13, Omentin-1 and eGFR were significantly lower than those in the non-renal injury group (P < 0.05). Serum Apelin-13 and Omentin-1 levels were negatively correlated with creatinine, blood urea nitrogen, cystatin C, β2-microglobulin and 24 h urinary protein, and positively correlated with eGFR in renal transplantation patients with postoperative renal injury (P < 0.05). The area under the curve (AUC) of Apelin-13 and Omentin-1 alone and their combination to predict postoperative renal injury were 0.784, 0.773 and 0.841, respectively. Apelin-13 and Omentin-1 were protective factors for renal function injury after renal transplantation (P < 0.05).
ConclusionSerum Apelin-13 and Omentin-1 are low in patients with renal injury after renal transplantation, which may be an early predictor.
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Keywords:
- renal transplantation /
- Apelin-13 /
- Omentin-1 /
- renal function injury
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表 1 2组血清Apelin-13、Omentin-1水平及肾功能指标比较(x±s)
指标 对照组(n=87) 肾移植组(n=89) Apelin-13/(ng/mL) 45.72±6.84 25.36±4.61* Omentin-1/(ng/mL) 226.45±36.82 126.53±31.26* 血肌酐/(μmol/L) 36.87±9.04 239.78±46.96* 血尿素氮/(mmol/L) 5.14±1.29 30.57±5.82* 胱抑素C/(mg/L) 0.79±0.18 3.76±0.48* β2-微球蛋白/(mg/L) 1.45±0.62 12.97±3.56* 估算肾小球滤过率/[mL/(min·1.73 m2)] 129.36±20.64 59.97±16.32* 24 h尿蛋白/g 0.12±0.02 1.46±0.37* 与对照组比较, * P < 0.05。 
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表 2 肾功能损伤组与非肾功能损伤组一般资料比较(x±s)[n(%)]
指标 非肾功能损伤组(n=68) 肾功能损伤组(n=21) t/χ2 P 男性 33(48.53) 13(61.90) 1.149 0.284 年龄/岁 45.25±10.44 45.47±10.24 0.085 0.933 糖尿病 12(17.65) 4(19.05) 0.021 0.884 收缩压/mmHg 114.76±17.13 116.18±18.02 0.328 0.744 舒张压/mmHg 76.84±8.35 76.27±8.46 0.273 0.786 甘油三酯/(mmol/L) 1.22±0.31 1.25±0.40 0.361 0.719 总胆固醇/(mmol/L) 3.94±0.72 4.03±0.85 0.479 0.633 低密度脂蛋白胆固醇/(mmol/L) 2.65±0.45 2.68±0.51 0.259 0.796 高密度脂蛋白胆固醇/(mmol/L) 1.21±0.23 1.19±0.20 0.359 0.721 供肾情况 0.651 0.420 尸体供肾 42(61.76) 15(71.43) 活体供肾 26(38.24) 6(28.57) 热缺血时间/min 5.24±1.16 5.27±1.20 0.103 0.918 冷缺血时间/h 7.32±1.75 7.40±1.84 0.181 0.857
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表 3 肾功能损伤组与非肾功能损伤组血清Apelin-13、Omentin-1水平及肾功能指标比较(x±s)
指标 非肾功能损伤组
(n=68)肾功能损伤组
(n=21)Apelin-13/(ng/mL) 27.34±6.75 18.94±4.07* Omentin-1/(ng/mL) 136.58±36.85 94.26±26.31* 血肌酐/(μmol/L) 192.54±46.89 392.75±80.62* 血尿素氮/(mmol/L) 23.72±5.38 52.74±8.45* 胱抑素C/(mg/L) 3.15±0.70 5.72±0.80* β2-微球蛋白/(mg/L) 10.60±2.31 20.64±4.16* 估算肾小球滤过率/[mL/(min·1.73 m2)] 67.49±10.32 35.62±8.35* 24 h尿蛋白/g 1.09±0.20 2.66±0.62* 与非肾功能损伤组比较, * P < 0.05。
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表 4 术后肾功能损伤的肾移植患者血清Apelin-13、Omentin-1水平与肾功能指标的相关性
指标 Apelin-13 Omentin-1 r P r P 血肌酐 -0.489 < 0.001 -0.498 < 0.001 血尿素氮 -0.492 < 0.001 -0.496 < 0.001 胱抑素C -0.476 < 0.001 -0.486 < 0.001 β2-微球蛋白 -0.491 < 0.001 -0.482 < 0.001 估算肾小球滤过率 0.503 < 0.001 0.509 < 0.001 24 h尿蛋白 -0.495 < 0.001 -0.501 < 0.001
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表 5 肾移植患者术后肾功能损伤的Logistic回归分析
影响因素 B SE Wald OR 95%CI P Apelin-13 -0.167 0.052 10.343 0.846 0.761~0.967 0.001 Omentin-1 -0.198 0.064 9.615 0.820 0.723~0.930 0.002
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