关键词: 尿液, 管型, 心脏移植, 移植时间, 他克莫司

Abstract:

Objective To analyze the positive rate of urine cast in patients after heart transplantation and its influencing factors. Methods From March 1 to June 30，2023，the urine samples of 143 patients undergoing heart transplantation were collected from the Outpatient Department of Union Hospital of Tongji Medical College of Huazhong University of Science and Technology. The urine samples were determined by cast microscopy and classified into cast positive group and cast negative group. The differences of general clinical data and relevant laboratory determination results were compared between cast positive group and cast negative group. Logistic regression analysis was used to evaluate the influencing factors of positive urine cast in patients after heart transplantation. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of relevant indicators in predicting positive urine cast in patients after heart transplantation. Results The positive rate of urine cast was 39.2% （56/143），and the positive rate of pathological cast was 42.9%（24/56）. In positive urine cast samples，the proportion of dry chemical urine protein negative samples was 75.0% （42/56）（easy to miss rate 75.0%）. The positive rates of urine cast were 57.5%（23/40），12.2%（5/41） and 45.2%（28/62） in the samples of <1 year，1-3 years and >3 years after transplantation，respectively. There was statistical significance in transplantation time，urea nitrogen，serum creatinine（SCr），cystatin C，glomerular filtration rate and tacrolimus use between cast positive and cast negative groups （P<0.05）. There was no statistical significance in gender，age，history of diabetes mellitus，history of hypertension，dry chemical urine protein，uric acid，direct bilirubin，B-type natriuretic peptide，ejection fraction，fasting blood glucose and glycated hemoglobin Alc （P>0.05）. The transplantation time <1 year [odds ratio （OR） was 5.537，95% confidence interval（CI） 1.669-18.372，P=0.001]，the transplantation time was >3 years（OR=7.442，95%CI 2.307-24.009，P=0.005）and tacrolimus≥8.3 ng·mL-1 （OR=2.781，95%CI 1.164-6.640，P=0.021） were independent risk factors for positive urine cast after heart transplantation. The area under curve of multi-indicator combined determination for positive urine cast after heart transplantation was 0.810，the sensitivity was 89.3%，and the specificity was 64.4%. Conclusions he positive rate of urine cast after heart transplantation is high，and it is easy to miss determination. Clinical attention should be paid to the determination of urine cast in patients with transplantation time <1 year，transplantation time >3 years and tacrolimus ≥8.3 ng·mL-1.

Key words: Urine, Cast, Heart transplantation, Transplantation time, Tacrolimus