血清白细胞介素-18和α_(1)-微球蛋白及肾损伤分子-1预测肺癌术后发生急性肾损伤的价值  

Values of serum interleukin-18,α_(1)-microglobulin and kidney injury molecule-1 to the prediction of postoperative acute kidney injury in lung cancer patients

作　　者：王正卫 牛垚飞 米艳芝 吴贺文 李基伟 WANG Zhengwei;NIU Yaofei;MI Yanzhi;WU Hewen;LI Jiwei(Department of Infectious Disease,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Thoracic Surgery,Henan Cancer Hospital,Zhengzhou,Henan 450003,China;Department of Cardiothoracic Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院、郑州大学人民医院感染科,河南郑州450003 [2]河南省肿瘤医院胸外科,河南郑州450003 [3]河南省人民医院、郑州大学人民医院心胸外科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第9期953-958,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200021)。

摘　　要：目的观察肺癌患者行根治术前后血清白细胞介素-18(IL-18)、α_(1)-微球蛋白(α_(1)-MG)和肾损伤分子-1(KIM-1)水平变化,探讨术后24 h IL-18、α_(1)-MG、KIM-1评估肺癌术后发生急性肾损伤(AKI)的价值。方法2020年10月—2022年10月河南省人民医院肺癌根治术后发生AKI患者50例为AKI组,肺癌根治术后未发生AKI者50例为无AKI组。比较2组年龄,性别比例,体质量指数(BMI),合并症,饮酒史,吸烟史,ASA分级,肿瘤位置,肿瘤组织病理类型,TNM分期,肿瘤分化程度,术前第1秒用力呼气容积(FEV_(1))占预计值百分比(FEV_(1)%prep)、血白蛋白(Alb)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、24 h尿蛋白定量(24h U-Pro)、血肌酐(SCr)、估算肾小球滤过率(eGFR)及术中尿量、术中出血量、麻醉时间、手术时间等指标;分别于术前及术后24 h检测2组血清IL-18、α_(1)-MG、KIM-1水平;多因素logistic回归分析肺癌根治术后发生AKI的影响因素;绘制ROC曲线评估术后24 h血清IL-18、α_(1)-MG、KIM-1水平预测肺癌根治术后发生AKI的效能。结果(1)2组年龄、性别比例、BMI、ASA分级、饮酒史、吸烟史、合并症、手术时间、麻醉时间、术中出血量、术中尿量、肿瘤部位、肿瘤病理类型、TNM分期、肿瘤分化程度及术前FEV_(1)%prep、TG、HDL-C、LDL-C、SCr、eGFR、血Alb、24 h U-Pro比较差异均无统计学意义(P>0.05)。(2)AKI组术前血清IL-18[(75.42±7.56)μg/L]、α_(1)-MG[(10.53±1.15)mg/L]、KIM-1[(1.52±0.15)ng/L]水平与无AKI组[(74.15±7.43)μg/L、(10.74±1.18)mg/L、(1.48±0.14)ng/L]比较差异均无统计学意义(t=0.847,P=0.399;t=0.901,P=0.370;t=1.378,P=1.171);AKI组术后24 h血清IL-18[(121.74±12.26)μg/L]、α_(1)-MG[(35.46±3.57)mg/L]、KIM-1[(2.23±0.24)ng/L]水平均高于术前(t=22.740,P<0.001;t=47.000,P<0.001;t=17.739,P<0.001);无AKI组术后24 h血清IL-18[(101.82±10.21)μg/L]、α_(1)-MG[(26.74±2.68)mg/L]Objective To observe the changes of serum interleukin-18(IL-18),α_(1)-microglobulin(α_(1)-MG)and kidney injury molecule-1(KIM-1)before and after lung cancer radical resection,and to investigate the values of IL-18,α_(1)-MG and KIM-1 levels 24 h after operation to the prediction of acute kidney injury(AKI)in lung cancer patients.Methods From October 2020 to October 2022,50 patients developed AKI after radical resection lung cancer(AKI group)and 50 patients developed no AKI after operation(non-AKI group).The age,gender ratio,body mass index(BMI),comorbidities,history of alcohol consumption,history of smoking,American Society of Anesthesiologists(ASA)classification,tumor location,tumor histopathological type,TNM stage,degree of tumor differentiation,the preoperative forced expiratory volume in one second as a percentage of the predicted value(FEV_(1)%prep),blood albumin(Alb),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),24-h urinary protein(24-h U-Pro),serum creatinine(SCr),estimated glomerular filtration rate(eGFR),intraoperative urine output,intraoperative blood loss,anesthesia duration and operation lasting time were compared between two groups.The levels of serum IL-18,α_(1)-MG and KIM-1 were detected preoperatively and 24 h postoperatively.Multivariate logistic regression was used to analyze the influencing factors of AKI in patients after operation.ROC curves were plotted to assess the values of serum IL-18,α_(1)-MG and KIM-1 levels 24 h postoperatively to the prediction of AKI after operation.Results(1)There were no significant differences in the age,gender ratio,BMI,ASA classification,history of alcohol consumption,history of smoking,comorbidities,operation lasting time,anesthesia duration,intraoperative blood loss,intraoperative urine output,tumor lolation,tumor histopathological type,TNM stage,degree of tumor differentiation,preoperative FEV_(1)%prep,TG,HDL-C,LDL-C,SCr,eGFR,blood Alb,and 24-h U-Pro between two groups(P>

关 键 词：肺癌 肺癌根治术 急性肾损伤 白细胞介素-18 α_(1)-微球蛋白 肾损伤分子-1 

分 类 号：R734.2[医药卫生—肿瘤] R692[医药卫生—临床医学]