血清白介素6与胱抑素C在早期预测对比剂肾病中的意义

Interleukin-6 and Cystatin C as Early Indicators to Predict Contrast Induced Nephropathy

目的探讨行经皮冠状动脉介入治疗(PCI)的老年急性冠脉综合征(ACS)患者术前和术后血清胱抑素C(CysC)、白介素6(IL-6)的变化在早期预测对比剂肾病(CIN)中的临床意义。方法选择2009年9月—2010年8月在我院接受PCI的老年ACS患者共190例,患者均采用低渗非离子型造影剂。根据传统的方法定义CIN,测定术前、术后12 h、24 h、48 h的血清肌酐(Cr)值。190例患者中,发生CIN的患者20例为CIN组,在同期未发生CIN的患者(共170例)中随机选取20例作为非CIN组。留取术前、术后2 h、8 h、24 h的血清样本,分别采用免疫比浊法检测CysC值,ELISA法检测IL-6值,并进行比较。结果 CIN组中,术后2 h的IL-6水平开始升高,但与术前比较差异无统计学意义(P>0.05);术后8 h、24 h与术前比较,差异有统计学意义(P<0.05)。CIN组术后8h、24 h的IL-6水平较非CIN组相应时间点明显升高,差异有统计学意义(P<0.05)。CIN组中,术后2 h、8 h的CysC值与术前比较,差异无统计学意义(P>0.05),术后24 h的CysC值与术前比较,差异有统计学意义(P<0.05)。CIN组与非CIN组比较,术后24 h患者的CysC值间差异有统计学意义(P<0.05)。CIN组中,血清IL-6及CysC水平与造影术后的Cr水平均呈正相关(P<0.05)。结论在老年ACS患者PCI术后,IL-6于术后8 h、CysC于术后24 h即明显升高,时间更早于血清Cr上升,可联合作为老年ACS患者PCI术后发生CIN的早期预测指标。

Objective To predict the early contrast induced nephropathy（CIN） by the change of serum cystatin C（CysC） and IL-6 in patients with acute coronary syndrome（ASC） who had undertaken percutaneous coronary intervention（PCI）.Methods Totally 190 patients with ACS who had undertaken PCI were enrolled from September 2009 to August 2010 in our hospital.All patients were given low-osmolar and nonionic contrast media.CIN was diagnosed according to the traditional method.The patients′ serum creatinine（Cr） levels before PCI,and at the 12th hour,24t hour,and 48th hour after PCI were assayed.There were 20 patients who suffered from CIN among all the 190 patients and they were defined as CIN group,and 20 patients were randomly chosen out of the 170 patients concurrently without CIN as non-CIN group.The serum samples adopted before PCI,and at the 2nd hour,8th hour and 24th hour after PCI were examined for assays of serum cystatin C（CysC） by Immunoturbidimetry and interleukin（IL）-6 by ELISA.The results were compared.Results The levels of serum IL-6 adopted at the 2nd hour after PCI began to increase in CIN group（P〉0.05） and significantly rose at the 8th and 48th hour than that adopted before PCI（P〈0.05）.The levels of serum IL-6 adopted at the 8th hour and 24th hour after PCI significantly increased in CIN group than in non-CIN group（P〈0.05）.In CIN group,there was no significant difference between the level of CysC adopted before PCI and those adopted at the 2nd and 8th hour after PCI（P〉0.05）,but there was a significant difference between the level of CysC adopted before PCI and that adopted at the 24th hour after PCI（P〈0.05）.There was a significant difference in CysC value at the 24th hour after PCI between the CIN group and non-CIN group（P〈0.05）.In CIN group the levels of serum IL-6 and CysC were positively correlated with that of Cr after PCI（P〈0.05）.Conclusion In patients with ACS,the level of IL-6 significantly increases at the 8th hour and the level of CysC increases at the 24th hour after PCI,even earlier than serum Cr.IL-6 and CysC could be used as early indicators to predict CIN after PCI.