体外循环心脏术后急性肾损伤患者血清胱抑素C、尿白细胞介素18和肌酐的变化及其临床意义

Changes and Clinical Significance of Cystatin C,Interleukin 18 in Acute Kidney Injury after Cardiac Surgeries with Extracorporeal Circulation

目的探讨接受体外循环心脏手术的患者血清胱抑素C（CysC）和尿白细胞介素18（IL-18）与急性。肾损伤（AKI）的关系及临床意义。方法根据AKI的诊断标准，将78例接受体外循环心脏手术的患者分为AKI组（24例）及非AKI组（54例），分别留取术前及术后不同时间点的血液和尿液标本，应用免疫比浊法检测血清CysC和Scr水平，ELISA法检尿IL-18水平。结果 AKI组血清Ser在术后24～48h内显著升高，上升≥26．5μmol／L或较基础Scr水平增加≥50％，符合AKI诊断，接受体外循环心脏手术的患者术后AKI发生率为30．77％；与术前相比，血清CysC在术后4h及尿IL-18在术后2h水平显著升高（P〈0．01）。与非AKI组比较，AKI组术后4h后各时间点血清CysC和术后2h后各时间点尿IL-18水平都之对应时间点显著升高。结论体外循环下接受心脏手术的患者AKI发生率较高，检测血清CysC和尿IL-18水平对预测体外循环心脏术后急性肾损伤患者的早期诊断和预后有重要指导价值。

To investigate the relationship between Cystatin C,Interleukin 18 and acute kidney injury（AKI） after cardiac surgery, and to estimate their clinical significance. Methods Based on the AKI diagnosis criterion, the study was conducted in 24 cases of AKI and 54 cases with no AKI undergoing cardiac surgery. Urine and serum samples were collected before and after operation to detect the serum Scr and CysC levels by turbidimetric immunoassay. Urinary IL - 18 was detected by ELISA. Results Serum Scr increased sig- nificantly in patients with AKI within 24 -48h hours after surgery. The absolute increase was over 26.52μmol/L or 50% increase above baseline, which met the AKI diagnosis criterion. The incidence of AKI after cardiac surgery was 30.77% . Compared with the cases before operation and without AKI, Serum CysC and Urinary IL-18 of AKI increased significantly （P 〈 0.01 ）. Conclusion The incidence of AKI after cardiac surgery with extracorporeal circulation is high. Serum CysC and Urinary IL-18 are useful markers for the early diagnosis and prognosis of AKI.