慢性肾炎急性感染期PCT与IL-6和TNF-α的变化及对器官功能的影响
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摘要
目的研究慢性肾炎患者急性感染期降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)的变化及对器官功能的影响。方法选取2015年8月-2017年6月43例慢性肾炎急性感染期患者为感染组,45例慢性肾炎患者为未感染组、22例健康体检人员为对照组。收集入组时三组研究对象和慢性肾炎患者治疗24h、治疗48h和治疗72h后,白细胞计数(WBC)、血清降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平和APACHEⅡ评分情况,分析炎症指标与患者肝功能、肾功能和肺功能的相关性。结果入组时三组研究对象WBC计数、PCT、IL-6、TNF-α水平和APACHEⅡ评分,感染组高于未感染组、对照组,未感染组高于对照组,差异均有统计学意义(P<0.05);治疗24h、48h,血清WBC计数、PCT、IL-6、TNF-α水平和APACHEⅡ评分,感染组高于未感染组(P<0.05);PCT、IL-6、TNF-α评价急性感染病情敏感度、特异性、阳性预测值均高于WBC计数;当炎症因子水平PCT≥11.1ng/ml、IL-6≥287.20ng/L和TNF-α≥248.00pg/ml患者肝功能、肾功能和肺功能较差。结论慢性肾炎急性感染期患者血清PCT、IL-6、TNF-α水平进一步升高,加重肺、肝、肾功能负担,造成器官不同程度损伤,致病情恶化;加强血清PCT、IL-6、TNF-α水平动态监测,利于评价病情、指导临床、改善预后,值得推广应用。
OBJECTIVE To explore the influence of changes of procalcitonin(PCT),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)on organ function of the patients with acute phase of chronic nephritis.METHODS Totally43 patients with acute phase of chronic nephritis who were treated in the hospital from Aug 2015 to Jun 2017 were assigned as the infection group,45 patients with chronic nephritis were chosen as the non-infection group,and 22 people who received physical examination were assigned as the control group.The white blood cell(WBC)counts,serum procalcitonin(PCT)level,interleukin-6(IL-6)level,tumor necrosis factor(TNF-α)level and APACHEⅡscore were observed and compared among the three groups of study objects at the enrollment and after the patients with chronic nephritis were treated for 24,48 and 72 hours.The correlation between the inflammatory factors and the liver function,renal function and pulmonary function was analyzed.RESULTS The levels of WBC,PCT,IL-6 and TNF-αand APACHE Ⅱscore of the infection group were higher than those of the non-infection group and the control group at the enrollment,while the levels of above indexes and APACHE Ⅱ score of the non-infection group were significantly higher than those of the control group(P<0.05).The levels of WBC,PCT,IL-6 and TNF-αand APACHE Ⅱscore were significantly higher in the infection group than in the non-infection group after the treatment for 24 and 48 hours(P<0.05).The sensitivity,specificity and positive predictive value of the PCT,IL-6 and TNF-αwere the higher than those of the WBC counts in evaluation of the acute infection.The patients with the PCT level no lower than 11.1 ng/ml,IL-6 level no lower than 287.20 ng/L and TNF-αno lower than 48.00 pg/ml had the poor liver,renal and pulmonary function.CONCLUSIONThe levels of serum PCT,IL-6 and TNF-αof the patients with acute phase of chronic nephritis are further elevated,which aggravates the pulmonary,hepatic and renal function and leads to the damage of organs in various degrees.The dynamic monitoring of the serum PCT,IL-6 and TNF-αmay facilitate the evaluation of illness condition,provide guidance for clinical treatment and improve the prognosis,and it is worthy to be promoted.
OBJECTIVE To explore the influence of changes of procalcitonin(PCT),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)on organ function of the patients with acute phase of chronic nephritis.METHODS Totally43 patients with acute phase of chronic nephritis who were treated in the hospital from Aug 2015 to Jun 2017 were assigned as the infection group,45 patients with chronic nephritis were chosen as the non-infection group,and 22 people who received physical examination were assigned as the control group.The white blood cell(WBC)counts,serum procalcitonin(PCT)level,interleukin-6(IL-6)level,tumor necrosis factor(TNF-α)level and APACHEⅡscore were observed and compared among the three groups of study objects at the enrollment and after the patients with chronic nephritis were treated for 24,48 and 72 hours.The correlation between the inflammatory factors and the liver function,renal function and pulmonary function was analyzed.RESULTS The levels of WBC,PCT,IL-6 and TNF-αand APACHE Ⅱscore of the infection group were higher than those of the non-infection group and the control group at the enrollment,while the levels of above indexes and APACHE Ⅱ score of the non-infection group were significantly higher than those of the control group(P<0.05).The levels of WBC,PCT,IL-6 and TNF-αand APACHE Ⅱscore were significantly higher in the infection group than in the non-infection group after the treatment for 24 and 48 hours(P<0.05).The sensitivity,specificity and positive predictive value of the PCT,IL-6 and TNF-αwere the higher than those of the WBC counts in evaluation of the acute infection.The patients with the PCT level no lower than 11.1 ng/ml,IL-6 level no lower than 287.20 ng/L and TNF-αno lower than 48.00 pg/ml had the poor liver,renal and pulmonary function.CONCLUSIONThe levels of serum PCT,IL-6 and TNF-αof the patients with acute phase of chronic nephritis are further elevated,which aggravates the pulmonary,hepatic and renal function and leads to the damage of organs in various degrees.The dynamic monitoring of the serum PCT,IL-6 and TNF-αmay facilitate the evaluation of illness condition,provide guidance for clinical treatment and improve the prognosis,and it is worthy to be promoted.
引文
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[9]Gluhovschi G,Gluhovschi C,Velciov S,et al."Surprise"in the evolution of chronic membranoproliferative glomerulonephritis associated with severe strongyloidiasis under corticotherapy:"hygienic paradox"[J].Renal Failure,2013,35(7):1017-1023.
[10]Wang YP,Li G,Ma LL,et al.Penehyclidine hydrochloride ameliorates renal ischemia-reperfusion injury in rats[J].J Surg Res,2014,186(1):390-397.
[11]Kheder-Elfekih R,Yannoutsos A,Blacher J,et al.Hypertension and chronic kidney disease:respective contribution of mean and pulse pressure and arterial stiffness[J].J Hypertens,2015,33(10):2010-2015.
[12]Pestana RM,Domingueti CP,Duarte RC,et al.Cytokines profile and its correlation with endothelial damage and oxidative stress in patients with type1diabetes mellitus and nephropathy[J].Immunol Res,2016,64(4):951-960.
[13]Teratani G,Awano S,Soh I,et al.Oral health in patients on haemodialysis for diabetic nephropathy and chronic glomerulonephritis[J].Clin Oral Investig,2013,17(2):483-489.
[14]Chaudhry AR,Chaudhry MR,Papadimitriou JC,et al.Bartonella henselae infection-associated vasculitis and crescentic glomerulonepritis leading to renal allograft loss[J].Transpl Infect Dis,2015,17(3):411-417.
[15]Sun L,Kanwar YS.Relevance of TNF-αin the context of other inflammatory cytokines in the progression of diabetic nephropathy[J].Kidney Int,2015,88(4):662-665.
[2]Hulok A,Sciborski K,Marczak J,et al.Soluble cell adhesion molecules-does estimating sVCAM-1and sICAM-1concentration provide additional information about cardiovascular risk in patient with coronary artery disease[J].Adv Clin Exp Med,2014,23(5):735-741.
[3]Chehade H,Rotman S,Fremeaux-Bacchi V,et al.Block of C5in severe acute postinfectious glomerulonephritis associated with anti-factor H autoantibody[J].Am J Kidney Dis,2016,68(6):944-948.
[4]陈有维,唐娟,何乐愚,等.血清PCT与sICAM-1sVCAM-1在慢性肾炎患者细菌感染中的应用[J].中华医院感染学杂志,2017,27(19):4359-4363.
[5]Couser WG,Johnson RJ.The etiology of glomerulonephritis:roles of infection and autoimmunity[J].Kidney Int,2014,86(5):905-914.
[6]邓菲,张萍,冯静,等.来氟米特对慢性肾小球肾炎大鼠炎症介质和免疫功能的影响[J].四川大学学报(医学版),2016,47(2):217-221.
[7]曾彩虹,刘志红.梅奥诊所/肾脏病理学会关于肾小球肾炎病理分类,诊断及报告共识[J].肾脏病与透析肾移植杂志,2016,25(3):261-268.
[8]中华人民共和国国家卫生和计划生育委员会.医院感染监测规范[S].卫办医政发[2009]126号.
[9]Gluhovschi G,Gluhovschi C,Velciov S,et al."Surprise"in the evolution of chronic membranoproliferative glomerulonephritis associated with severe strongyloidiasis under corticotherapy:"hygienic paradox"[J].Renal Failure,2013,35(7):1017-1023.
[10]Wang YP,Li G,Ma LL,et al.Penehyclidine hydrochloride ameliorates renal ischemia-reperfusion injury in rats[J].J Surg Res,2014,186(1):390-397.
[11]Kheder-Elfekih R,Yannoutsos A,Blacher J,et al.Hypertension and chronic kidney disease:respective contribution of mean and pulse pressure and arterial stiffness[J].J Hypertens,2015,33(10):2010-2015.
[12]Pestana RM,Domingueti CP,Duarte RC,et al.Cytokines profile and its correlation with endothelial damage and oxidative stress in patients with type1diabetes mellitus and nephropathy[J].Immunol Res,2016,64(4):951-960.
[13]Teratani G,Awano S,Soh I,et al.Oral health in patients on haemodialysis for diabetic nephropathy and chronic glomerulonephritis[J].Clin Oral Investig,2013,17(2):483-489.
[14]Chaudhry AR,Chaudhry MR,Papadimitriou JC,et al.Bartonella henselae infection-associated vasculitis and crescentic glomerulonepritis leading to renal allograft loss[J].Transpl Infect Dis,2015,17(3):411-417.
[15]Sun L,Kanwar YS.Relevance of TNF-αin the context of other inflammatory cytokines in the progression of diabetic nephropathy[J].Kidney Int,2015,88(4):662-665.