肾移植后蛋白尿与移植肾组织学改变和生存的关系

宋3

摘要：蛋白尿症与肾脏移植后移植肾的低存活率相关。在这里我们评估了蛋白尿症，移植肾的组织病变以及其存活的关系。受试人群包括613名患蛋白尿症，并在肾脏移植1年后接受了组织活检的受移植者。发现276名（45%）患者的尿蛋白水平高于150毫克/日，其中182名尿蛋白小于500毫克/日. 在大于84%，甚至其尿蛋白处在低水平的患者中都患有蛋白尿症。
Abstract: Proteinuria is associated with reduced kidney allograft survival. Herein we assessed the association between proteinuria, graft histology and survival. The cohort included 613 kidney allograft recipients who had proteinuria (measured) and surveillance biopsies at 1-year posttransplant. Proteinuria >150 mg/day was detected in 276 patients (45%) and in 182 of these, proteinuria was below 500. In >84% of patients even low levels of proteinuria were associated with albuminuria.
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蛋白尿症与肾小球的病变以及西罗莫司（免疫抑制剂）的使用相关。在80%的尿蛋白水平大于1500毫克/日的患者的组织活检中发现了肾小球病变。然而，在移植后1年（的检查中），较低的尿蛋白水平并没有伴随特异性的病变。而与没有使用西罗莫司（的患者）相比，西罗莫司的使用和更高的蛋白尿症(发病率)(40%对76%，p<0.0001）以及更高的蛋白排泄量相关(378 + 997毫克 vs. 955 + 1986毫克 每天, p < 0.0001)。
$ m* d  T5 P: ]5 dProteinuria was associated with the presence of graft glomerular pathology and the use of sirolimus. Eighty percent of patients with proteinuria >1500 mg/day had glomerular pathology on biopsy. However, lower levels of proteinuria were not associated with specific pathologies at 1 year.Compared to no sirolimus, sirolimus use was associated with higher prevalence of proteinuria (40% vs. 76%, p < 0.0001) and higher protein excretion (378 + 997 vs. 955 + 1986 mg/day, p < 0.0001).

& r" r2 ~) \9 {+ Z蛋白尿症与更低的移植体生存率有关(HR = 1.40, p = 0.001)，这个比例并不依赖于其他的危险因素，如肾小球病变，移植体不能行使功能，接受移植的年龄，以及急性的免疫排斥反应等。失去移植肾的主要病理原因是肾小球病变，特别是那些接受移植1年后尿蛋白依然>500毫克每日的患者。因此，在45%的受移植1年后的患者中存在的尿蛋白通常都是处在一个低水平（<500毫克每日）。然而，即使这样低水平的蛋白尿症也意味着相当低的移植物存活率。蛋白尿症和肾小球病变各自独立地影响移植肾的存活。
Proteinuria was associated with reduced graft survival (HR = 1.40, p = 0.001) independent of other risk factors including, glomerular pathology, graft function, recipient age and acute rejection. The predominant pathology in lost allografts (n = 57) was glomerular, particularly in patients with 1-year proteinuria >500. Thus, proteinuria, usually at low levels (<500 mg/day), is present in 45% of recipients at 1 year. However, and even low levels of proteinuria relate to poor graft survival. Proteinuria and glomerular pathology relate independently to survival.
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' q1 W9 d! U# n- u5 @+ e大意：研究者对613名进行肾脏移植1年的患者进行了蛋白尿症的检查和组织活检，发现高的尿蛋白水平(>500)和肾小球的组织病变密切相关，而这种高的尿蛋白水平与西罗莫司（免疫抑制剂）的使用的关系也非常密切。低的尿蛋白水平（即使仍然患有蛋白尿症）并不伴随着肾小球的病变。肾小球的病变是移植体丧失功能的主要因素之一，所以至少蛋白尿处于低水平的患者不必担心他们会因为组织病变失去移植的肾脏。但是，蛋白尿症本身（即使尿蛋白水平很低，也不伴随肾小球病变）也会导致移植肾的死亡。肾小球的病变和蛋白尿症对移植肾脏的损害是独立的，并不互相依赖。

爱之甚

坐坐老大的沙发啊 呵呵..。好好学了中..........

宋3

客氣了.共同進步![24]