婴儿先天性心脏病体外循环术后肾损伤分析

Kidney injury after cardiopulmonary bypass in infants with congenital heart disease

目的探讨婴儿先天性心脏病(简称先心病)体外循环(CPB)术后肾损伤情况。方法选取我院2009年10月至2010年7月期间CPB下行先心病手术的婴儿40例,分别于转流前、手术结束时、术后2 h、术后6 h、术后24 h用酶联免疫吸附法(ELISA)检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、半胱氨酸蛋白酶抑制剂C(CysC)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)浓度。常规生化方法检测术前及术后血清肌酐(Cr)及尿素氮(BUN)浓度。结果术前与术后血清Cr及BUN均在正常范围内;血清TNF-α、IL-6和尿NAG浓度在CPB后均有显著性升高(P<0.05)。相关性分析提示血清TNF-α分别与尿NAG、血清CysC呈正相关(r分别为0.195,0.190,均P<0.05),血清IL-6与尿NAG亦呈正相关(r=0.278,P<0.01);血清CysC和尿NAG检测出肾损伤的阳性率显著高于血清Cr或BUN(均P<0.01)。结论 CPB能引起婴儿急性肾损伤,可能与血清中TNF-α和IL-6的浓度增高相关。血清CysC和尿NAG可作为反映肾功能变化较敏感的指标。

Objective To study kidney injury in infants with congenital heart disease（CHD） who underwent cardiac surgery with cardiopulmonary bypass（CPB）.Methods Forty CHD infants undergoing cardiac surgery with CPB from October 2009 to July 2010 were enrolled.The concentrations of serum tumor necrosis factor-alpha（TNF-α）,interleukin-6（IL-6）,cystatin C（CysC） and urinary N-acetyl-beta-D-glucosaminidase（NAG） were detected using ELISA before bypass,at the end of surgery,and 2 hrs,6 hrs and 24 hrs after surgery.Serum concentrations of creatinine（Cr） and urea nitrogen（BUN） were measured with conventional biochemistry technique before and after surgery.Results The concentrations of serum Cr and BUN were normal before and after surgery.After CPB,the concentrations of serum TNF-α and IL-6 and urinary NAG increased significantly（P〈0.05）.Serum TNF-α was positively correlated with urinary NAG and serum CysC（r=0.195,0.190,respectively;both P〈0.05）.Serum IL-6 was positively correlated with urinary NAG（r=0.278,P〈0.01）.The positive rate in kidney injury was detected by serum CysC and urinary NAG were significantly higher than by serum Cr or BUN（both P〈0.01）.Conclusions CPB can cause acute kidney injury in infants,which may be correlated with the increase in the concentrations of serum TNF-α and IL-6.Serum CysC and urinary NAG may be used as sensitive markers for reflecting the changes of renal function.