血浆白细胞介素-18、硫化氢水平对先天性心脏病患儿术后并发急性肺损伤的诊断价值

Diagnostic value of plasma interleukin-18 and hydrogen sulfide levels for postoperative acute lung injury in children with congenital heart disease

目的探讨先天性心脏病(CHD)患儿血浆白细胞介素-18(IL-18)、硫化氢(H 2S)水平变化及其对术后并发急性肺损伤(ALI)的诊断价值。方法选择2018年3月至2020年3月于郑州大学第一附属医院行手术治疗的CHD患儿85例作为CHD组,根据术后是否出现ALI将CHD组患儿分为ALI组(n=13)和非ALI组(n=72);另选择同期体检健康儿童85例作为对照组。采用酶联免疫吸附实验检测各组儿童血浆IL-18水平,采用亚甲基蓝法测定血浆H 2S水平,比较各组儿童血浆IL-18、H 2S水平,采用受试者工作特征(ROC)曲线评估血浆IL-18、H 2S水平对CHD患儿术后ALI的诊断价值。结果CHD组患儿术前、术后3 d血浆IL-18水平均显著高于对照组,H 2S水平均显著低于对照组(P<0.05);CHD组患儿术后3 d血浆IL-18、H 2S水平均显著高于术前(P<0.05)。术前,ALI组与非ALI组患儿血浆IL-18和H 2S水平比较差异无统计学意义(P>0.05);术后,ALI组患儿血浆IL-18和H 2S水平显著高于非ALI组(P<0.05)。血浆IL-18和H 2S水平联合预测CHD患儿术后并发ALI的准确度、特异度、敏感度均显著高于IL-18和H 2S单独检测(P<0.05)。结论CHD术后并发ALI患儿血浆IL-18、H 2S水平呈上升趋势,联合检测血浆IL-18和H 2S水平是预测CHD患儿术后并发ALI的可靠指标。

Objective To explore the changes of the levels of plasma interleukin-18(IL-18)and hydrogen sulfide(H 2S)and their diagnostic value for postoperative acute lung injury(ALI)in children with congenital heart disease(CHD).Methods A total of 85 CHD patients who underwent surgery in the First Affiliated Hospital of Zhengzhou University from March 2018 to March 2020 were selected as CHD group.According to presence or absence of postoperative ALI,they were divided into the ALI group(n=13)and non-ALI group(n=72).A total of 85 healthy children who underwent physical examination during the same period were selected as control group.The level of plasma IL-18 of the children in the every group was detected by enzyme linked immunosorbent assay.The level of plasma H 2S of the children in the every group was detected by methylene blue method.The levels of plasma IL-18 and H 2S were compared among all the groups.The diagnostic value of plasma IL-18 and H 2S for postoperative ALI in CHD children was evaluated by receiver operating characteristic(ROC)curves.Results Before operation and 3 d after operation,the level of IL-18 in the CHD group was significantly higher than that in the control group,and the level of H 2S was significantly lower than that in the control group(P<0.05).Before operation,there was no significant difference in the levels of IL-18 and H 2S of children between the ALI group and non-ALI group(P>0.05);after operation,the levels of plasma IL-18 and H 2S of the patients in the ALI group were significantly higher than those in the non-ALI group(P<0.05).The accuracy,specificity and sensitivity of plasma IL-18 combined with H 2S for predicting postoperative ALI in CHD patients were higher than those of single index of IL-18,H 2S(P<0.05).Conclusion The levels of plasma IL-18 and H 2S in CHD patients combined with ALI after surgery showed an upward trend.The combined detection of plasma IL-18 and H 2S can provide a more accurate prediction for postoperative ALI in children with CHD.