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目的分析接受体外循环心脏手术患者术后尿白细胞介素(IL)-18、血清胱抑素C(Cys C)与急性肾损伤(AKI)的关系及其临床意义。方法选取2012年12月至2015年1月收治的接受体外循环心脏手术的80例患者作为研究对象,按术后是否合并AKI分为AKI组(n=25)与非AKI组(n=55),分别取术前、术后不同时间段患者尿液及血液标本,采用免疫比浊法测定血清Cys C水平,用酶联免疫吸附法测定尿液中IL-18水平,分析两者与AKI的关系。结果 80例接受体外循环心脏手术患者,术后25例发生AKI,占31.25%。AKI组术后血肌酐(Scr)峰值在术后48 h内,其术后24、48及72 h Scr水平[(107.55±47.66)μmol/L、(114.32±50.13)μmol/L、(85.96±23.47)μmol/L]明显高于非AKI组[(65.85±17.93)μmol/L、(59.61±10.85)μmol/L、(59.07±10.22)μmol/L,P均<0.01];手术4、6、12、24、48 h后,AKI组血清Cys C水平上升明显,且与非AKI组对比差异有统计学意义(P<0.05,P<0.01);AKI组术后2、4、6、8、12 h尿IL-18水平[(4.45±1.17)μg/L、(5.88±2.73)μg/L、(3.51±1.35)μg/L、(3.42±1.53)μg/L、(3.61±1.81)μg/L]明显高于非AKI组[(0.97±0.51)μg/L、(1.10±0.72)μg/L、(1.24±0.83)μg/L、(1.31±0.92)μg/L、(1.24±0.87)μg/L,P均<0.01]。AKI组术后12 h Scr水平分别与2 h尿IL-18水平(r=0.63,P<0.05)、术后4 h血清Cys C水平(r=0.724,P<0.05)呈正相关,术后4 h血清Cys C与术后2 h尿IL-18水平亦呈正相关(r=0.656,P<0.05)。结论尿IL-18与血清Cys C均为反映肾小球滤过功能的有效指标,可在早期检出急性肾损害,为心脏术后AKI患者的早期诊断与治疗提供参照。
Objective To analyze the relationship between urinary interleukin (IL) -18, serum cystatin C (Cys C) and acute kidney injury (AKI) after cardiopulmonary bypass surgery and its clinical significance. Methods Eighty patients undergoing cardiopulmonary bypass during December 2012 to January 2015 were enrolled in this study. AKI group (n = 25) and non-AKI group (n = 55) were enrolled in this study. , Respectively, before and after surgery at different time intervals in patients with urine and blood samples, serum immunoglobulin Cys C levels were measured by enzyme-linked immunosorbent assay for urinary IL-18 levels, both with AKI relationship. Results Eighty patients undergoing cardiopulmonary bypass surgery developed AKI in 25 patients (31.25%). The postoperative peak value of Scr in AKI group was significantly higher than that in the control group within 48 hours after operation (Scr level [(107.55 ± 47.66) μmol / L, (114.32 ± 50.13) μmol / L, (85.96 ± 23.47) μmol / L] were significantly higher than those in the non-AKI group (65.85 ± 17.93 μmol / L, 59.61 ± 10.85 μmol / L, 59.07 ± 10.22 μmol / L, (P <0.05, P <0.01). After 12, 24 and 48 hours, the levels of serum Cys C increased significantly in AKI group, and there was significant difference compared with non-AKI group (4.45 ± 1.17) μg / L, (5.88 ± 2.73) μg / L, (3.51 ± 1.35) μg / L, (3.42 ± 1.53) μg / L, (3.61 ± 1.81) μg / L, (1.24 ± 0.83) μg / L, (1.31 ± 0.92) μg / L, (1.24 ± 0.83) μg / L, 0.87) μg / L, P <0.01]. Scr levels at 12 h after AKI were positively correlated with 2 h urinary IL-18 level (r = 0.63, P <0.05) and serum Cys C level at 4 h after operation (r = 0.724, P < h serum Cys C and urinary IL-18 levels after 2 hours also showed a positive correlation (r = 0.656, P <0.05). Conclusions Urinary IL-18 and serum Cys C are both effective indicators of glomerular filtration function. Early detection of acute renal injury can provide a reference for the early diagnosis and treatment of AKI after cardiac surgery.