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

作　　者：孙玲 谢兴元 曲强 刘敬[3] 肖菲[1] Sun Ling;Xie Xing-yuan;Qu Qiang;Liu Jing;Xiao Fei(Pediatric renal Rheumatology and immunology Department of Chenzhou First People's Hospital,Chenzhou 423000,China;PICU of Chenzhou First People's Hospital,Chenzhou 423000,China;Pediatric Cardiothoracic Vascular Center of Chenzhou First People's Hospital,Chenzhou 423000,China)

机构地区：[1]郴州市第一人民医院儿童肾脏风湿免疫科,郴州423000 [2]郴州市第一人民医院儿童重症监护科,郴州423000 [3]郴州市第一人民医院儿童心胸血管中心,郴州423000

出　　处：《临床肾脏病杂志》2022年第7期567-573,共7页Journal Of Clinical Nephrology

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 gelatinase associated 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(7Objective 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 stay[9.7(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 stay[15.7(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 time[5.7(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)d]of 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-2[2.4(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-6[41.3(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-8[52.9(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-10[46.8(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/L]in sera and L-FABP[63.2(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],NGAL[18.3(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

关 键 词：先天性心脏病 急性肾损伤 炎症因子 儿童 

分 类 号：R726.5[医药卫生—儿科]