血小板参数与同种异体肾移植术后移植肾功能延迟恢复的关系

目的 探讨同种异体肾移植患者术后移植肾功能延迟恢复（DGF）与外周血血小板参数变化的关系。方法 应用回顾性研究方法，选取2016年7月至2018年5月在海军军医大学（第二军医大学）长海医院器官移植科接受同种异体肾移植术的患者109例，根据术后是否发生DGF分为DGF组（n=41）和非DGF（non-DGF）组（n=68）。分别采集两组患者术前及术后1、3、7、14 d的外周血，检测血小板计数（PLT）、大型血小板比值（P-LCR）、平均血小板体积（MPV）、血小板分布宽度（PDW）、血小板比容（PCT），观察上述指标的动态变化并进行组间比较。采用受试者工作特征（ROC）曲线分析上述指标预测同种异体肾移植术后DGF的价值。结果 肾移植术前DGF组与non-DGF组血小板参数差异无统计学意义。肾移植术后1、3、7、14 d，DGF组PLT始终低于non-DGF组，MPV始终高于non-DGF组，且在术后7 d时差异均有统计学意义（P均<0.05）；肾移植术后DGF组与non-DGF组PCT均呈先降低后升高趋势，术后7 d时DGF组PCT低于non-DGF组且差异有统计学意义（P<0.05）；肾移植术后DGF组与non-DGF组PDW和P-LCR均呈先升高后降低趋势，术后7 d时DGF组PDW大于non-DGF组且差异有统计学意义（P<0.05），而P-LCR在DGF组和non-DGF组之间差异无统计学意义（P=0.184）。肾移植术后7 d PDW和PCT预测DGF的ROC曲线下面积分别为0.781和0.758，最佳截断值分别为16.75 fL和0.155%，特异度分别为92.6%和63.2%，灵敏度分别为61.0%和75.6%。结论 对接受同种异体肾移植术的患者进行血小板参数的动态监测有助于DGF的早期诊断，移植术后7 d PDW>16.75 fL、PCT<0.155%时患者发生DGF的风险增加。

Relationship between platelet parameters and delayed graft function after renal transplantation

Objective To explore the relationship between the changes of platelet parameters after renal transplantation and delayed graft function (DGF). Methods A retrospective analysis was conducted with 109 patients who underwent allograft renal transplantation from Jul. 2016 to May 2018 in the Department of Organ Transplantation of Changhai Hospital, Naval Medical University (Second Military Medical University). The patients were divided into DGF group (n=41) and non-DGF group (n=68). Peripheral blood samples were collected from the two groups before and at 1, 3, 7 and 14 d after operation. The platelet parameters, including platelet count (PLT), platelet-large cell ratio (P-LCR), mean platelet volume (MPV), platelet volume distribution width (PDW) and platelet hematocrit (PCT), were dynamically monitored. Receiver operating characteristic (ROC) curve was used to analyze the value of the platelet parameters for predicting DGF after renal transplantation. Results There was no significant difference in platelet parameters between the DGF group and the non-DGF group before operation. At 1, 3, 7, and 14 d after renal transplantation, PLT values in the DGF group were lower than those in the non-DGF group, MPV values were higher than those in the non-DGF group, with statistical significance found at 7 d after renal transplantation (both P<0.05). PCT in the DGF group was decreased first and then increased after renal transplantation. At 7 d after operation, PCT in the DGF group was markedly lower than that in the non-DGF group (P<0.05).PDW and P-LCR in the DGF group and the non-DGF group increased first and then decreased after renal transplantation. At 7 d after operation, PDW in the DGF group was markedly higher than that in the non-DGF group (P<0.05). There was no significant difference in P-LCR between the two groups at 7 d after operation (P=0.184). At 7 d after operation, the area under ROC curve for PDW and PCT were 0.781 and 0.758, with the optimal cut-off values being 16.75 fL and 0.155%, specificity being 92.6% and 63.2%, and sensitivity being 61.0% and 75.6%, respectively. Conclusion Dynamic monitoring of platelet parameters early after renal transplantation is helpful for the early diagnosis of DGF. There is an increased risk of DGF in patients with PDW>16.75 fL and PCT<0.155% at 7 d after operation.