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

摘要:

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。

Abstract:

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.