| Background:Kidney transplantation is currently one of the renal replacement therapy method, a transplant success rate gradually rise, but in postoperative rejection and infection is still patients with renal transplantation long-term survival graft, so the transplanted kidney graft function of the monitoring is become clinical work focus. Creatinine is currently the most common clinical marker of evaluation renal function.Cystatin C is considered the ideal endogenous marker in reflect glomerular filtration function. But acute renal transplantation rejection and infection in the early evaluation function has not been seen reports at home and abroad.Objectives:Through monitoring renal transplant patients serum cystatin C (Cys C) and blood creatinine (Scr) concentration change rule and mutual relationship, discusses the Cys C renal transplantation especially in auxiliary diagnosis of acute rejection or infection in the early stages of clinical application value.Methods:(1)According to statistics Selected from June 2009 to December 2010 in shanxi second people's hospital renal transplant kidney dialysis center line allogeneic transplant 80 patients, including male 58 cases (72.5%), female 22 patients (27.5%), average age 36.35±11.75 years (16～67), preoperative rule hemodialysis average time 10.05±10.23 months (1～36 months). Follow-up renal transplantation within 3 weeks of material,80 patients were divided into three groups: stable group (group A) 40 cases, the male 34 cases, female 6 cases; Acute rejection group (group B) 20 cases, occurred in postoperative 2～7 days, the male 11 cases and female 9 cases;Infection group (group C) 20 cases, occurred in postoperative 7～14 days, including male 13 cases, female 7 cases.So cases were selected and exclusion standard according to relevant literature.(2)Specimen sampling and testing:Every fasting's patients in the groups extract peripheral venous blood 5 ml in morning from the day of surgery and postoperative 1,2,3,4,5,6,7,10,14, 18,20 days, separat on serum within two hours to prepare.Cys C and Scr of serum concentrations utilize Hitachi 7020 full-automatic Biochemical analysis instrument.Detection method of Cys C makes use of particle enhance immune turbidity; creatinine mensuration use sarcosine oxidase method.(3)Using the statistical software SPSS13.0 to statistical analysis, data comparison of each group make use of repeated measures ANOVA, clinical accuracy evaluation use the receiver operating characteristic curve.Results:(1) During the two days of the kidney transplantation,Cys C and Scr are dropped sharply, then become stable. Infection group and stable group changes with time downtrend is roughly same, rejection group is clearly different from the other two groups, the decline is not obvious changes over time, Each Cys C changed with time trend was statistically significant (P<0.001);(2) Comparing rejection group with the other groups, Cys C and Scr decreased obviously, the difference was statistically significant(P<0.001); Comparing stable group with rejection group, Cys C and Scr has not obvious difference,The change was not statistically significant (P=1.0);(3) In acute rejection group,Cys C diagnostic efficiency of significant statistically significant (P <0.001), ROC curves under area (AUC) for 0.858,, best truncation value for 1.66 mg/L; Scr diagnostic efficiency and a significant statistically significant (P<0.001), ROC curves under area (AUC) for 0.897, best truncation value for 134.5 umol/L. Comparing Cys C with Scr,ROC curves under area was not statistically significant (P>0.05);(4) In infection group,ROC curves under area of Scr and Cys C is 0.538 and 0.596, diagnostic efficiency were not statistically significant performance (P>0.2). Cys C and Scr area under the curve compared, difference also was not statistically significant (P>0.05).Conclusion:(1) Cys C and Scr are sensitive reflect early renal impairment evaluation marker;(2) Cys C in reflecting the graft of acute rejection has certain predictability,and can be used as one of markers for early diagnosis of acute rejection in renal transplantation;(3) Cys C were not diagnostic value when infection occurs in early evaluation of renal transplantation;(4) compared Scr with Cys C, The diagnostic efficiency of reflecting acute rejection in renal transplantation did not show obvious superiority, may be related with the experimental design, with the specific mechanism needs further research.
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