炎症因子对先天性心脏病患儿术后并发急性肾损伤的预测作用

    Prediction of inflammation cytokines for acute kidney injury after congenital heart disease surgery in children

    • 摘要: 目的 探讨炎症因子对先天性心脏病术后患儿继发急性肾损伤(acute kidney injury,AKI)的预测作用。方法 选择2018年2月至2020年12月在郴州市第一人民医院住院治疗的先天性心脏病并予体外循环心肺转流术患儿139例。根据术后48 h内是否合并AKI分为合并AKI组和未合并AKI组。根据AKI是否进展分为AKI进展组和AKI未进展组。比较合并AKI组与未合并AKI组、AKI进展组和AKI未进展组患儿的血炎症指标[白细胞介素(interleukin,IL)-2、IL-4、IL-6、IL-8、IL-10,肿瘤坏死因子α(tumor necrosis factor-α,TNF-α),干扰素-γ(interferon-γ,IFN-γ)]、尿肝脏型脂肪酸结合蛋白(liver fatty acid binding protein,L-FABP)和中性粒细胞凝胶酶相关脂质运载蛋白(neutrophil gelatinaseassociated lipocalin,NGAL)水平的差异,分析上述因子与发生AKI和AKI进展的相关性,并利用受试者工作特征曲线下面积(area under the curve,AUC)对上述生物标记物对AKI发生发展的预测作用。结果 合并AKI组与未合并AKI组、术后AKI进展组与AKI无进展组的患儿相比,体外循环心肺转流术(cardiopulmonary bypass,CBP)时间[(133.6±31.5)min比(102.8±19.8)min,142.6(52.5,288.6)min比115.7(64.8,69.4)min]、主动脉阻断时间[(68.5±29.7)min比(52.0±36.5)min,73(56.5,93.8)min比56(40.5,72.2)min]、儿童重症监护室住院时间[9.7(6.4,17.2)d比4.2(2.2,7.2)d,11.5(10.6,15.5)d比5.3(4.3,9.7)d]、总住院时间[15.7(11.3,19.2)d比9.5(8.5,13.5)d,21.7(15.8,32.6)d比10.2(9.4,17.6)d]、机械通气时间[5.7(1.4,12.2)d比2.8(2.0,8.9)d,7.7(5.2,18.7)d比4.8(2.2,12.2)d]均延长(P<0.05)。合并AKI组与未合并AKI组、AKI进展组与AKI无进展组患儿相比,术后首日血IL-2[2.4(1.1,2.7)ng/L比0.9(0.5,2.3)ng/L,2.9(1.1,3.6)ng/L比1.3(1.1,1.9)ng/L]、IL-6[41.3(6.1,86.5)ng/L比3.1(1.2,3.9)ng/L,56.4(7.7,108.6)ng/L比38.5(6.3,74.2)ng/L]、IL-8[52.9(16.8,100.2)ng/L比2.9(1.9,4.3)ng/L,84.5(43.3,168.7)ng/L比45.2(9.6,84.3)ng/L]、IL-10[46.8(7.1,136.4)ng/L比1.3(0.8,7.7)ng/L,66.7(7.9,244.8)ng/L比38.2(6.8,106.7)ng/L]和尿L-FABP[63.2(4.2,167.3)ng/L比4.5(2.4,6.5)ng/L,94.6(3.9,268.7)ng/L比25.8(5.6,103.2)ng/L]、NGAL水平[18.3(10.9,46.3)ng/L比3.6(1.8,5.2)ng/L,29.3(16.7,85.4)ng/L比9.6(1.1,25.6)ng/L]均升高(P<0.05)。受试者工作特征曲线分析提示,血IL-6、IL-8、尿L-FABP、NGAL对术后继发AKI有预测作用,其AUC分别为0.79、0.81、0.75、0.74(P<0.05)。血IL-8和尿L-FABP对术后AKI进展有预测作用,其AUC分别为0.82和0.81(P<0.05)。结论 AKI患儿血IL-6、IL-8、尿L-FABP、NGAL相比未合并AKI患儿异常升高,对术后是否合并AKI具有预测价值;AKI进展患儿血IL-8和尿L-FABP相比AKI未进展患儿异常升高,对术后AKI是否持续进展具有预测价值。

       

      Abstract: Objective To explore the value of inflammation cytokines for predicting the postoperative occurrence of acute kidney injury(AKI)after surgery for congenital heart disease in children. Methods From February 2018 to November 2020,139 cases of congenital heart disease undergoing cardiopulmonary bypass surgery were recruited and divided into two groups of AKI and non-AKI. Children in AKI group were further divided into AKI with progression and AKI without progression according to whether or not renal function worsened persistently. The groups were compared with regards to the levels of interleukin(IL)-2,IL-4,IL-6,IL-8,IL-10,tumor necrosis factor-α(TNF-α),interferon-γ (IFN-γ)in sera and liver fatty acid binding protein(L-FABP),neutrophil gelatinase-associated lipocalin (NGAL)in urine. Correlation analysis was performed between those factors and AKI and AKI occurring predicated by area under the ROC curve (AUC). Results Cardiopulmonary bypass (CBP) time(133. 6±31. 5)min vs(102. 8±19. 8)min,142. 6(52. 5,288. 6)min vs 115. 7(64. 8,69. 4)min, aortic cross-clamp time(68. 5±29. 7)min vs(52. 0±36. 5)min,73(56. 5,93. 8)min vs 56(40. 5, 72. 2)min,PICU stay9. 7(6. 4,17. 2)d vs 4. 2(2. 2,7. 2)d,11. 5(10. 6,15. 5)d vs 5. 3(4. 3,9. 7) d,hospital stay15. 7(11. 3,19. 2)d vs 9. 5(8. 5,13. 5)d,21. 7(15. 8,32. 6)d vs 10. 2(9. 4,17. 6) d,mechanical ventilation time5. 7(1. 4,12. 2)d vs 2. 8(2. 0,8. 9)d,7. 7(5. 2,18. 7)d vs 4. 8(2. 2, 12. 2)dof AKI and AKI with progression groupa were longer than those of non-AKI and AKI without progression groups(P<0. 05). The levels of IL-22. 4(1. 1,2. 7)ng/L vs 0. 9(0. 5,2. 3)ng/L,2. 9 (1. 1,3. 6)ng/L vs 1. 3(1. 1,1. 9)ng/L,IL-641. 3(6. 1,86. 5)ng/L vs 3. 1(1. 2,3. 9)ng/L,56. 4 (7. 7,108. 6)ng/L vs 38. 5(6. 3,74. 2)ng/L,IL-852. 9(16. 8,100. 2)ng/L vs 2. 9(1. 9,4. 3)ng/L, 84. 5(43. 3,168. 7)ng/L vs 45. 2(9. 6,84. 3)ng/L,IL-1046. 8(7. 1,136. 4)ng/L vs 1. 3(0. 8,7. 7) ng/L,66. 7(7. 9,244. 8)ng/L vs 38. 2(6. 8,106. 7)ng/Lin sera and L-FABP63. 2(4. 2,167. 3) ng/L vs 4. 5(2. 4,6. 5)ng/L,94. 6(3. 9,268. 7)ng/L vs 25. 8(5. 6,103. 2)ng/L,NGAL18. 3 (10. 9,46. 3)ng/L vs 3. 6(1. 8,5. 2)ng/L,29. 3(16. 7,85. 4)ng/L vs 9. 6(1. 1,25. 6)ng/Lin urine at Day 1 post-operation were higher in AKI and AKI with progression groups than those in non-AKI and AKI without progression groups(P<0. 05). ROC analysis revealed that IL-6,IL-8,L-FABP and NGAL could predict the occurrence of AKI with AUC 0. 79,0. 81,0. 75 and 0. 74(P<0. 05)respectively. Furthermore,serum IL-8 and urinary L-FABP could predict the progression of AKI with AUC 0. 82 and 0. 81(P<0. 05). Conclusion IL-6,IL-8,L-FABP and NGAL are obviously elevated in AKI so that they have prediction values of AKI. And marked elevations of IL-8 and L-FABP in children with AKI progression offer prediction values for AKI progression.

       

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