抑炎因子IL-35与移植肾功能延迟恢复关系的研究

目的  探讨白细胞介素（IL）-35与移植肾功能恢复情况之间的关系。方法  回顾性分析45例心脏死亡器官捐献（DCD）供肾肾移植受体的临床资料。根据肾移植术后是否发生移植物功能延迟恢复（DGF），所有受体分为早期肾功能恢复良好（IGF）组（32例）和DGF组（13例）。比较肾移植术后1、2、3、7、14、28 d及术后3个月、6个月、1年各时间点两组受体的血清肌酐（Scr）和估算肾小球滤过率（eGFR）水平；比较肾移植术后1、2、3、7、14、28 d各时间点两组受体血清和尿液IL-35含量。结果  DGF组受体术后肾功能恢复迟缓，术后7 d时Scr水平高于IGF组，eGFR水平低于IGF组，差异均有统计学意义（均为P < 0.05）。术后1年，两组受体Scr水平的差异无统计学意义，但eGFR仍存在较大差异，与IGF组相比，DGF组受体术后1年时eGFR仍降低（P < 0.05）。术后1、2、3、7、14 d，DGF组血清中IL-35含量均低于IGF组，两组比较差异均有统计学意义（均为P < 0.05）；术后28 d，与IGF组相比，DGF组血清IL-35含量反而升高，两组比较差异有统计学意义（P < 0.05）。术后1、2、3、7 d，DGF组尿液中IL-35含量均低于IGF组，两组比较差异均有统计学意义（均为P < 0.05）；术后14、28 d，两组受体尿液IL-35含量进行比较，差异均无统计学意义（均为P > 0.05）。结论  肾移植术后受体血清和尿液中IL-35含量低与DGF发生存在一定的联系，提示术后早期受体全身和移植肾局部抑炎应答过弱，过度的炎症应答得不到有效控制，可能是DGF发生的重要原因。

Study on the relationship between anti-inflammatory cytokine IL-35 and delayed renal graft function

Objective To investigate the relationship between the interleukin (IL)-35 and the recovery of renal graft function. Methods Clinical data of 45 recipients receiving renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the presence of delayed graft function (DGF) after renal transplantation, all recipients were divided into the immediate graft function (IGF) group (n=32) and DGF group (n=13). The serum creatinine (Scr) level and estimated glomerular filtration rate (eGFR) in the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d and 3, 6 and 12 months after renal transplantation. The IL-35 levels in the serum and urine samples of the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d following renal transplantation. Results In the DGF group, the renal function was restored slowly. Compared with the IGF group, the Scr level was significantly higher, whereas the eGFR was considerably lower in the DGF group at postoperative 7 d (both P < 0.05). At 1 year after surgery, there was no significant difference in the Scr level between two groups. Compared with the IGF group, the eGFR in the DGF group was significantly lower at postoperative 1 year (P < 0.05). At 1, 2, 3, 7, 14 d after operation, the serum levels of IL-35 in the DGF group were evidently lower than those in the IGF group (all P < 0.05). Compared with the IGF group, the serum level of IL-35 in the DGF group was significantly increased at postoperative 28 d (P < 0.05). At postoperative 1, 2, 3, 7 d, the IL-35 levels in the urine samples in the DGF group were significantly lower than those in the IGF group (all P < 0.05). At postoperative 14 and 28 d, the IL-35 levels in the urine samples did not significantly differ between two groups (both P > 0.05). Conclusions The low levels of IL-35 in the serum and urine of recipients after renal transplantation are associated with the incidence of DGF to certain extent, prompting that excessively weak systemic and local anti-inflammatory responses early after renal transplantation and uncontrolled excessive inflammatory response are probably the pivotal causes of DGF.