尿IL-18对冠状动脉介入诊疗术后对比剂肾病的早期诊断价值  

Urine interleukin-18 as early indicator to predict contrast-induced nephropathyin patients undergoing PCI or CAG

作　　者：何海燕[1] 李文华[2] 赵昕[2] 刘加立[2] 钱文浩[2] 李东野[2] 

机构地区：[1]江苏省徐州医学院 [2]徐州医学院附属医院心血管内科

出　　处：《中华全科医学》2014年第12期1935-1937,共3页Chinese Journal of General Practice

摘　　要：目的探讨经皮冠状动脉造影（Coronary angiography,CAG）和/或冠状动脉介入治疗（Percutaneous coronary intervention,PCI）术后患者尿白介素18（Interleukin-18,IL-18）浓度的变化,评价其在对比剂肾病（Contrast-induced Nephropathy,CIN）中的早期预测价值。方法连续收集徐州医学院附属医院心血管内科2012年3—9月连续行CAG和/或PCI的180例患者的一般临床资料,收集患者术前和术后2 h、6 h、12 h、24 h、48 h尿液,用酶联免疫吸附法（Enzyme-linked immunospecific assay,ELISA）检测尿IL-18浓度,于术前3 d内及术后24 h、48 h采集静脉血3ml,用于Scr检测。结果 1180例纳入患者共发生16例CIN,CIN的发生率为8.9%。CIN组患者尿IL-18浓度于术后2 h开始升高,但与术前比较差异无统计学意义（P〉0.05）;术后6 h、12 h、24 h尿IL-18浓度与术前比较明显升高（P〈0.05）,而术后48 h Scr与术前比较差异有统计学意义（P〈0.05）。2ROC曲线示术后12 h尿IL-18曲线下面积为0.811,95%CI（0.735～0.888,P〈0.05）,检测截断点为815.61 pg/ml时诊断CIN的敏感度与特异度分别为87.5%和62.2%。3单变量分析结果示术前、术后尿IL-18浓度与肌酐成正相关（P〈0.05）。结论尿IL-18对冠心病患者行冠脉诊疗介入术后发生CIN具有良好的预测价值。Objective To explore the change of urinary Interleukin-18 （IL-18） levels after coronary angiography（CAG） and percutaneous coronary intervention（PCI） ,and evaluate its predictive value in early diagnosis of Contrast-induced ne- phropathy（CIN）. Methods The general clinical data of 180 patients were collected in patients who underwent coronary interventional procedure from the department of Cardiology, Affiliated Hospital of Xuzhou Medical College from March, 2012 to September,2012. Before and 2 h,6 h, 12 h,24 h,48 h urinary IL-18 samples were measured by using enzyme linked immune sorbent assay（ELISA） kits. 3d preoperative and postoperative within 24 h,48 b conducted venous blood 3ml were used to detect Set. Results （1）CIN was diagnosed in 16 of 180 patients ,the incidence rate was 8.9%. In CIN group, urinary IL-18 concentration increased after 2h of the procedure, but the difference was not significant preoperative differences （P 〉 0.05 ） ;after 6h, 12h ,24h of the procedure, urine IL-18 levels rose significantly compared with the preop- erative （ P 〈 0.05 ） ; while the Scr level of 48h after operation was a significant difference （ P 〈 0.05 ）. （3）The area under the ROC curve of urinary IL-18 12 h after the operation was O. 811, confidence interval of AUC 95% was（0. 735, 0. 888）. If the cutoff point of the diagnosis of CIN was 815.61 pg/ml,the sensitivity was 87.5% and the specificity was 62.2%. （2）Analysis showed that preoperative, postoperative urinary IL-18 and serum creatinine was positively related to the single variable （ P 〈 0.05 ）. Conclusion Urinary IL-18 has good predictive value for the early diagnosis of CIN in pa- tients with coronary interventional procedure.

关 键 词：白细胞介素18 对比剂肾病 早期诊断 

分 类 号：R541.4[医药卫生—心血管疾病] R692[医药卫生—内科学]