肾损伤分子1和白细胞介素18在体外循环心脏术后急性肾损伤中的应用研究

摘要

目的：探讨尿中肾损伤分子1(kidney injury molecule-1,KIM-1)和白细胞介素18(Interleukin-18,IL-18)在体外循环心脏手术后急性肾损伤(Acute kidney injury,AKI)中的应用.方法：119例体外循环心脏手术患者,根据AKI诊断标准分为AKI组和非AKI组,分别采集患者手术前后不同时间点的血液和尿液标本,采用酶法进行血肌酐(Scr)测定、ELISA法进行尿KIM-1和尿IL-18测定.结果：119例体外循环心脏手术患者术后,有29例患者在24~48 h内Scr绝对值升高≥26.4μmol/L,或Scr较基础值升高≥50%,符合AKI诊断标准,AKI发生率为24.3%.与术前相比,AKI组患者尿KIM-1术后4 h开始升高、尿IL-18术后6 h开始升高,差异均具有统计学意义(P<0.01).尿KIM-1和尿IL-18与血Scr呈正相关,相关系数分别为0.886和0.812(P<0.01).尿KIM-1在AKI诊断中ROC曲线下面积为0.855,95%可信区间为0.717~0.993(P<0.01)；尿IL-18在AKI诊断中ROC曲线下面积为0.823,95%可信区间为0.661~0.985(P<0.01).结论：检测尿KIM-1和尿IL-18对于体外循环心脏手术患者发生AKI的早期诊断及预后判断具有重要意义.%　　Objective:To Investigate the clinical significance of kidney injury molecule-1(KIM-1) and Interleukin-18(IL-18) in acute kidney injury(AKI) after cardiac surgeries with extracorporeal circulation. Method:Divided 119 patients undergone cardiac surgeries into AKI group and non-AKI group according to the AKI criterion. Collected the urine and serum samples before cardiac surgeries and different time point samples after cardiac surgeries. Detected serum Scr by enzyme method and urine KIM-1,IL-18 by ELISA. Result:The serum Scr level of 29 patients absolutely increased over 26.4μmol/L or 50%increase above the baseline,they were accord with the AKI criterion. Campared with patients before surgeries ,the 29 AKI patients urine KIM-1 level evidently increased in 4 hours and IL-18 in 6 hours(P<0.01). The urine level of KIM-1 and IL-18 were positively correlated with serum Scr(P<0.01). The area under the ROC of urine KIM-1 was 0.855(95%CI 0.717-0.993);the area under the ROC of urine IL-18 was 0.823(95%CI 0.661-0.985). Conclusion:The urine levels of KIM-1 and IL-18 are increased much earlier than serum Scr level;Derected the urine KIM-1 and IL-18 have important significance for early diagnosis and prognosis to the AKI patients after cardiac surgeries with extracorporeal circulation.