[1]王坤英a,张蓬杰,王剑茹b,等.肾移植受者早期血清25- 羟基维生素D 水平对急性排斥反应的预测价值研究[J].现代检验医学杂志,2024,39(04):138-142.[doi:10.3969/j.issn.1671-7414.2024.04.025]
　WANG Kunyinga,ZHANG Pengjie,WANG Jianrub,et al.Study on the Predictive Value of Serum 25-Hydroxyvitamin D Level in Early Renal Transplantation for Acute Rejection[J].Journal of Modern Laboratory Medicine,2024,39(04):138-142.[doi:10.3969/j.issn.1671-7414.2024.04.025]
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肾移植受者早期血清25- 羟基维生素D 水平对急性排斥反应的预测价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年04期
页码:
138-142
栏目:
论著
出版日期:
2024-07-15

文章信息/Info

Title:
Study on the Predictive Value of Serum 25-Hydroxyvitamin D Level in Early Renal Transplantation for Acute Rejection
文章编号:
1671-7414（2024）04-138-05
作者:
王坤英a; 2; 张蓬杰3; 王剑茹1b; 陈好雨1c; 游瑞君1a; 梁娇霞1a
（1. 山西省第二人民医院a. 肾病实验室；b. 医教科；c. 肾移植中心，太原 030012；2. 山西省针灸医院门诊办，太原 030006；3. 陕西省人民医院肾病血透中心，西安 710068）
Author(s):
WANG Kunying1a; 2; ZHANG Pengjie3;  WANG Jianru1b;  CHEN Haoyu1c; YOU Ruijun1a; LIANG Jiaoxia1a
（1a. Nephropathy Laboratory；1b. Department of Medical Education；1c. Department of Kidney Transplantation Center，the Second People’s Hospital of Shanxi Province, Taiyuan 030012, China；2. Shanxi Acupuncture Hospital Outpatient Office, Taiyuan 030006, China；3. Nephropathy Hemodialysis Center, Shaanxi Provincial People’s Hospital, Xi’an 710068, China）
关键词:
肾移植; 25- 羟基维生素D; 急性排斥反应
分类号:
R699.2；R446.112
DOI:
10.3969/j.issn.1671-7414.2024.04.025
文献标志码:
A
摘要:
目的 探讨血清25- 羟基维生素D［25-hydroxy vitamin D, 25(OH)D］水平对肾移植急性排斥反应（acuterejection，AR）的预测价值。方法 选取2019 年1 月～ 2022 年8 月山西省第二人民医院同种异体肾移植受者324例。收集受者临床资料，分别采用化学发光免疫法和比色法检测移植术后早期（１月内）血清25(OH)D，甲状旁腺素（parathyroid hormone，PTH）和钙、磷水平，记录检测季节，观察移植术后一年内是否发生AR。定义25(OH)D 水平≥ 20ng/ml 为正常，≥ 12ng/ml~ ＜ 20ng/ml 为不足和＜ 12ng/ml 为缺乏，并分为25(OH)D 正常组（n=106）、不足组（n=112）和缺乏组（n=106）。按照是否发生AR 分为AR 组（n=51）和非AR 组（n=273）。分析血清25(OH)D 水平基本情况，比较25(OH)D 三组血清PTH，钙、磷水平和季节以及AR 发生率的差异，多因素Logistic 回归分析AR 发生的影响因素，受试者工作特征（receiver operating characteristic，ROC）曲线分析血清25(OH)D 水平对AR 的预测价值。结果 血清25(OH)D 缺乏或不足发生率为67.28%（218/324）。25(OH) 正常组、不足组和缺乏组血清PTH 水平分别为75.44（46.42，113.23）pg/ml，78.29（58.27，152.10）pg/ml 和86.84（54.64，127.3）pg/ml，AR 发生率分别为2.47%（8/324），6.17%（20/324）和7.10%（23/324），均为缺乏组最高，正常组最低，差异具有统计学意义（H==6.784，χ2=8.580，均P ＜ 0.05)。25(OH)D 缺乏（OR=3.340，95% CI：1.409 ～ 7.916），25(OH)D 不足（OR=2.442，95% CI：1.006 ～ 5.925）和人类白细胞抗原（human leucocyte antigen，HLA）错配（4~6 个）（OR=2.117，95% CI：1.027 ～ 4.363）是AR 发生的独立危险因素（均P ＜ 0.05）。血清25(OH)D 水平预测AR 的曲线下面积（area under curve, AUC）为0.702（95% CI：0.625 ～0.779），最佳截断值为13.59ng/ml，特异度和灵敏度分别为66.7％，65.6％。结论 25(OH)D 缺乏（＜ 12ng/ml）或不足（≥ 12ng/ml ～＜ 20ng/ml）是肾移植患者发生AR 的独立危险因素，血清25（OH）D 水平对AR 有一定预测价值。
Abstract:
Objective To investigate the predictive value of serum 25-hydroxyvitamin D [25(OH)D] level in early renal transplantation for acute rejection (AR). Methods A total of 324 renal transplant recipients from January 2019 to August 2022 in the Second People’s Hospital of Shanxi Province were selected. The clinical data of the recipients were collected. The levels of serum 25(OH)D, parathyroid hormone (PTH), and calcium, phosphorus in early (within 1 month) transplantation were detected by chemiluminescence immunoassay and colorimetry, respectively. The detection season was recorded, and the occurrence of AR within 1 year after renal transplantation was observed. The 25(OH)D level ≥ 20ng/ml was defined as normal, ≥ 12 ng/ml ～ < 20 ng/ml as insufficient and < 12ng/ml as deficient，they were divided into of 25(OH)D normal group（n=106）, insufficient group（n=112）and deficient group（n=106）. According to the occurrence of AR, they were divided into AR group (n=51) and non-AR group (n=273). The basic situation of serum 25(OH)D level was analyzed. The differences in serum PTH, calcium, phosphorus levels and seasons as well as AR incidence among the three groups of 25(OH)D were compared. Multivariate logistic regression was used to analyze the influencing factors of AR, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum 25(OH)D level for AR. Results The incidence of serum 25(OH)D deficiency or insufficiency was 67.28% (218/324). In the 25(OH)D normal group, insufficient group and deficiency group, the serum PTH levels were 75.44 (46.42，113.23) pg/ml, 78.29 (58.27，152.10) pg/ml and 86.84 (54.64，127.3)pg/ml, and the incidences of AR were 2.47% (8/324), 6.17% (20/324) and 7.10%(23/324), respectively. All of them were the highest in the deficiency group and the lowest in the normal group, and the differences were significant (H = 6.784, χ2 = 8.580, all P ＜ 0.05). Additionally, 25(OH)D deficiency (OR = 3.340, 95% CI: 1.409 ～ 7.916), 25(OH)D insufficiency (OR = 2.442, 95% CI: 1.006 ～ 5.925) and human leucocyte antigen (HLA) mismatch (4 ～ 6) (OR = 2.117, 95% CI: 1.027 ～ 4.363) were independent risk factors for AR (all P ＜ 0.05). The area under the curve (AUC) of serum 25(OH)D level in predicting AR was 0.702 (95% CI: 0.625 ～ 0.779), the optimal cut-off value was 13.59 ng/ml, the specificity and the sensitivity were 66.7 % and 65.6 %，respectively. Conclusion In this study, 25(OH)D deficiency (< 12ng / ml) or insufficiency ( ≥ 12 ～ < 20ng / ml) was an independent risk factor for AR, and serum 25(OH)D level may have a certain predictive value for AR.

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备注/Memo

备注/Memo:
基金项目：山西省卫生健康委“四个一批”科技兴医创新计划重点攻关专项（2023XM027）。
作者简介：王坤英（1978-），女，硕士，副主任技师，研究方向：肾病检验及研究，Email: wangkunying_2000@163.com。
通讯作者：张蓬杰（1975-），男，硕士，副主任医师，研究方向：肾病临床及研究,E-mail:13149254918@163.com。
更新日期/Last Update: 2024-07-15