白介素-6联合中性粒细胞明胶酶相关载脂蛋白对紫绀型先天性心脏病患儿体外循环术后急性肾损伤的预测价值  

Predictive value of serum IL-6 combined with NGAL for acute kidney injury undergoing cardiopulmonary bypass in cyanotic children

作　　者：范春玲 刘永哲 FAN Chun-ling;LIU Yong-zhe(Department of Anesthesiology,Peking University Shougang Hospital,Beijing 100144,China;Department of Anesthesiology of the Third Medical Center of Chinese PLA General Hospital,Beijing 100059,China)

机构地区：[1]北京大学首钢医院麻醉科,北京市100144 [2]中国人民解放军总医院第三医学中心麻醉科

出　　处：《中国心血管病研究》2023年第8期697-703,共7页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项项目(首发2020-2-5092)。

摘　　要：目的探究血白介素-6(IL-6)联合中性粒细胞明胶酶相关载脂蛋白(NGAL)对紫绀型先天性心脏病(CCHD)患儿体外循环(cardiopulmonary bypass,CPB)术后急性肾损伤(acute kidneyinjury,AKI)的预测价值。方法选取2020年12月至2022年4月解放军总医院第七医学中心小儿心脏外科接受CPB手术的38例CCHD患儿的临床资料。根据国际肾病改善全球预后标准诊断AKI,根据术后是否发生AKI将患儿分为AKI组(n=12)与非AKI组(n=26)。分别于气管插管后(T_(1))、超滤结束后(T_(2))、CPB结束后3 h(T_(3))、CPB结束后8 h(T_(4))、CPB结束后24 h(T_(5))记录各时间点的尿胱抑素C(CysC)、血IL-6、血NGAL、鼻咽温、平均动脉压(MAP)。采用受试者工作特征(ROC)曲线分析IL-6联合NGAL对CCHD患儿CPB术后AKI的预测价值。结果与非AKI组相比,AKI组在T_(3)时NGAL、IL-6明显升高(P<0.05),T_(4)与T_(5)时CysC、NGAL、IL-6显著升高(P<0.05)。ROC曲线分析结果显示,无论是在T_(3)、T_(4)或T_(5)时IL-6联合NGAL较二者单独预测AUC更大,敏感度及特异度更高。T_(3-5)IL-6联合NGAL敏感度分别为83.3%、100%、100%,特异度均为84.6%,曲线下面积(AUC)分别为0.885、0.910、0.962。结论血IL-6联合NGAL可作为早期预测CCHD患儿CPB术后AKI的良好生物标志物。Objective To investigate the predictive value of serum interleukin-6(IL-6)combined with neutrophil gelatinase⁃associated lipocalin(NGAL)for acute kidney injury(AKI)in infants with cyanotic congenital heart disease(CCHD)after cardiopulmonary bypass(CPB).Methods The clinical data of 38 infants with CCHD who underwent CPB operation in the pediatric cardiac surgery department of the Seventh Medical Center of the PLA General Hospital were selected.AKI was diagnosed according to the International Nephropathy Improving global prognosis criteria and the infants were divided into the AKI group(n=12)and non-AKI group(n=26)according to whether AKI occurred after the surgery.The urinary cystatin C(CysC),serum IL-6,NGAL,pharyngeal temperature and mean arterial pressure(MAP)were recorded at each time point respectively after tracheal intubation(T_(1)),ultrafiltration(T_(2)),3 h after CPB surgery(T_(3)),8 h after CPB surgery(T_(4))and 24 h after CPB surgery(T_(5)).Receiver operating characteristic(ROC)curve was used to analyze the predictive value of IL-6 and NGAL for AKI in infants with CCHD after CPB.Results Compared with non-AKI group,NGAL and IL-6 carbon oxide partial pressure differ-increased significantly in AKI group at T_(3)(P<0.05);and CysC,NGAL and IL-6 increased obviously at T_(4)and T_(5)(P<0.05).ROC curve analysis results showed that the AUC predicted by IL-6 combined with NGAL at T_(3),T_(4)or T_(5)was greater,and the sensitivity and specificity were higher than those predicted by the two alone.The sensitivity of IL-6 combined with NGAL at T_(3-5)were 83.3%,100%and 100%respectively the specificity was 84.6%and the AUC were 0.885,0.910 and 0.962,respectively.Conclusions Serum IL-6 combined with NGAL could be used as good biomarkers for early prediction of AKI in infants with CCHD after CPB.

关 键 词：白介素-6 中性粒细胞明胶酶相关载脂蛋白 体外循环 急性肾损伤 预测价值 

分 类 号：R614[医药卫生—麻醉学]