心衰合并急性肾衰竭患者尿L-FABP、IL-18表达与预后的相关性
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摘要
目的检测心衰合并急性肾衰竭(ARF)患者尿肝型脂肪酸结合蛋白(L-FABP)、白细胞介素-18(IL-18)表达情况,分析二者与预后的相关性。方法选择2012年6月至2016年6月收治的心衰合ARF患者112例作为观察组,选择同期体检的健康者90例作为对照组,采用酶联免疫吸附(ELISA)法检测尿L-FABP及IL-18水平,所有患者每半年随访1次,调查并记录患者随访期间内发病情况、再住院情况及死亡情况。结果观察组心衰合并ARF患者尿L-FABP、IL-18水平均高于对照组(P<0.05);Ⅳ级心功能级别患者尿L-FABP、IL-18水平显著高于Ⅱ、Ⅲ级患者,Ⅲ级心功能级别患者显著高于Ⅱ级患者(P<0.05);2年随访结束后,患者死亡16例(14.29%),未死亡96例(85.71%);尿L-FABP、IL-18高表达组患者死亡、再次住院及未住院发生率显著高于低表达组(P<0.05);患者尿L-FABP与IL-18水平表达呈明显正相关。结论心衰合并ARF患者尿L-FABP、IL-18高表达,与患者心功能级别、预后情况有关,可能作为预测及评估心衰合并ARF患者预后情况的指标。
Objective To detect the expressions of urinary L-FABP and serum IL-18 in patients with heart failure complicated by acute renal failure, and to analyze their correlations with prognosis of patients.Methods A total of 112 patients with heart failure complicated by acute renal failure admitted who were admitted and treated in our hospital from June 2012 to June 2016 were enrolled as observation group,at the same time, 90 healthy subjects who underwent physical examination in our hospital were enrolled as control group.The enzyme linked immunosorbent assay(ELISA) was used to detect the levels of urinary L-FABP and serum IL-18,and all the patients were followed up once every six months,the incidence of disease,rehospitalization status and death of patients during follow up were observed and compared between the two groups.Results The levels of urinary L-FABP and serum IL-18 in observation group were significantly higher than those in control group(P<0.05).The levels of urinary L-FABP and serum IL-18 in grade Ⅳ patients were significantly higher than those in grade Ⅱ and Ⅲ patients,which in grade Ⅲ patients were significantly higher than those in grade Ⅱ patients(P<0.05).After 2-year follow up,16 patients died(14.29%),and 96 patients were survival(85.71%).Moreover the incidences of death,rehospitalization and non-hospitalization in patients with high expressions of urinary L-FABP and serum IL-18 were significantly higher than those in patients with low expressions of urinary L-FABP and serum IL-18(P<0.05).In addition there was a positive correlation between the expression levels of urinary L-FABP and those of IL-18.Conclusion The high expressions of L-FABP and IL-18 are related to the cardiac function and prognosis of patients with heart failure complicated by acute renal failure,which can be regarded as the indexes to predict patient's prognosis.
Objective To detect the expressions of urinary L-FABP and serum IL-18 in patients with heart failure complicated by acute renal failure, and to analyze their correlations with prognosis of patients.Methods A total of 112 patients with heart failure complicated by acute renal failure admitted who were admitted and treated in our hospital from June 2012 to June 2016 were enrolled as observation group,at the same time, 90 healthy subjects who underwent physical examination in our hospital were enrolled as control group.The enzyme linked immunosorbent assay(ELISA) was used to detect the levels of urinary L-FABP and serum IL-18,and all the patients were followed up once every six months,the incidence of disease,rehospitalization status and death of patients during follow up were observed and compared between the two groups.Results The levels of urinary L-FABP and serum IL-18 in observation group were significantly higher than those in control group(P<0.05).The levels of urinary L-FABP and serum IL-18 in grade Ⅳ patients were significantly higher than those in grade Ⅱ and Ⅲ patients,which in grade Ⅲ patients were significantly higher than those in grade Ⅱ patients(P<0.05).After 2-year follow up,16 patients died(14.29%),and 96 patients were survival(85.71%).Moreover the incidences of death,rehospitalization and non-hospitalization in patients with high expressions of urinary L-FABP and serum IL-18 were significantly higher than those in patients with low expressions of urinary L-FABP and serum IL-18(P<0.05).In addition there was a positive correlation between the expression levels of urinary L-FABP and those of IL-18.Conclusion The high expressions of L-FABP and IL-18 are related to the cardiac function and prognosis of patients with heart failure complicated by acute renal failure,which can be regarded as the indexes to predict patient's prognosis.
引文
1 左丽娅.心衰合并急性肾衰竭患者连续性血液净化的临床疗效分析.当代医学,2016,22:88-89.
2 刘惠.不同血液净化方式对肾功能衰竭患者生活质量的影响.中国实用护理杂志,2012,28:55-56.
3 朱贤慧.急性心力衰竭心肾阳虚证生物学标志物与预后相关性研究.新中医,2015,47:21-24.
4 Liu S,Che M,Xue S,et al.Urinary L-FABP and its combination with urinary NGAL in early diagnosis of acute kidney injury after cardiac surgery in adult patients.Biomarkers,2013,18:95-101.
5 何文娜,刘伟,方晓武,等.老年患者急性心肾综合征的危险因素及预后分析.岭南心血管病杂志,2014,20:521-525.
6 班遵浦.连续性血液净化治疗心衰患者合并急性肾衰竭的疗效分析.中国中西医结合肾病杂志,2015,16:261-262.
7 康晓征,赵勇,乐磊,等.肝型脂肪酸结合蛋白对比白介素18对肝硬化失代偿期急性肾损伤患者的诊断价值.安徽医科大学学报,2018,53:1289-1293.
8 黄娟,袁伟杰.肝型脂肪酸结合蛋白在肾脏疾病进展中的作用及诊断价值.中华肾脏病杂志,2012,28:733-735.
9 李国明.IL-18在心力衰竭发生、发展中的作用及机制.世界最新医学信息文摘,2015,15:98-100.
10 Girard-guyonvarc HC,Palomo J,Martin P,et al.Unopposed IL-18 signaling leads to severe TLR9-induced macrophage activation syndrome in mice.Blood,2018,131:1430-1441.
11 周丽霞.尿胱抑素C和白介素-18 对危重新生儿急性肾损伤的预测价值.中国妇幼保健,2014,29:2907-2909.
12 Mallat Z,Heymes C,Corbaz A,et al.Evidence for altered interleukin (IL)-18 pathway in human heart failure.FASEB J,2004,18:1752-1754.
13 黄云芳,陈文莉,方珣.肝型脂肪酸结合蛋白在重症患者急性肾损伤早期诊断中的意义.武汉大学学报(医学版),2011,32:793-795.
14 刘赵云,姜德谦,唐晓鸿,等.慢性充血性心力衰竭IL-18的表达及意义.实用预防医学,2007,14:507-508.
15 Ferguson MA,Vaidya VS,Waikar SS,et al.Urinary liver-type fatty acid-binding protein predicts adverse outcomes in acute kidney injury.Kidney Int,2010,77:708-714.
16 郑新明,高月花,那宇,尿中肝型脂肪酸结合蛋白及白细胞介素 18 对急性肾损伤预后的预测作用.中国中西医结合肾病杂志,2016,17:777-780.
17 Parr SK,Clark AJ,Bian A,et al.Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.Kidney Int,2015,87:640-648.
2 刘惠.不同血液净化方式对肾功能衰竭患者生活质量的影响.中国实用护理杂志,2012,28:55-56.
3 朱贤慧.急性心力衰竭心肾阳虚证生物学标志物与预后相关性研究.新中医,2015,47:21-24.
4 Liu S,Che M,Xue S,et al.Urinary L-FABP and its combination with urinary NGAL in early diagnosis of acute kidney injury after cardiac surgery in adult patients.Biomarkers,2013,18:95-101.
5 何文娜,刘伟,方晓武,等.老年患者急性心肾综合征的危险因素及预后分析.岭南心血管病杂志,2014,20:521-525.
6 班遵浦.连续性血液净化治疗心衰患者合并急性肾衰竭的疗效分析.中国中西医结合肾病杂志,2015,16:261-262.
7 康晓征,赵勇,乐磊,等.肝型脂肪酸结合蛋白对比白介素18对肝硬化失代偿期急性肾损伤患者的诊断价值.安徽医科大学学报,2018,53:1289-1293.
8 黄娟,袁伟杰.肝型脂肪酸结合蛋白在肾脏疾病进展中的作用及诊断价值.中华肾脏病杂志,2012,28:733-735.
9 李国明.IL-18在心力衰竭发生、发展中的作用及机制.世界最新医学信息文摘,2015,15:98-100.
10 Girard-guyonvarc HC,Palomo J,Martin P,et al.Unopposed IL-18 signaling leads to severe TLR9-induced macrophage activation syndrome in mice.Blood,2018,131:1430-1441.
11 周丽霞.尿胱抑素C和白介素-18 对危重新生儿急性肾损伤的预测价值.中国妇幼保健,2014,29:2907-2909.
12 Mallat Z,Heymes C,Corbaz A,et al.Evidence for altered interleukin (IL)-18 pathway in human heart failure.FASEB J,2004,18:1752-1754.
13 黄云芳,陈文莉,方珣.肝型脂肪酸结合蛋白在重症患者急性肾损伤早期诊断中的意义.武汉大学学报(医学版),2011,32:793-795.
14 刘赵云,姜德谦,唐晓鸿,等.慢性充血性心力衰竭IL-18的表达及意义.实用预防医学,2007,14:507-508.
15 Ferguson MA,Vaidya VS,Waikar SS,et al.Urinary liver-type fatty acid-binding protein predicts adverse outcomes in acute kidney injury.Kidney Int,2010,77:708-714.
16 郑新明,高月花,那宇,尿中肝型脂肪酸结合蛋白及白细胞介素 18 对急性肾损伤预后的预测作用.中国中西医结合肾病杂志,2016,17:777-780.
17 Parr SK,Clark AJ,Bian A,et al.Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.Kidney Int,2015,87:640-648.