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IL-6 and CysC as Early Indicatiors to Preict CIN

Author: ZhuangCongMing
Tutor: LiuYingFeng
School: Southern Medical University,
Course: Cardiovascular within science
Keywords: Interleukin- 6 Cystatin C Percutaneous coronary intervention treatment Acute kidney injury Contrast Induced Nephropathy Early Prediction
CLC: R692
Type: Master's thesis
Year: 2011
Downloads: 62
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Abstract

Background In order to facilitate the observation of vascular lumen internal morphology, contrast agent is widely used in diagnostic imaging and treatment of the whole process. 1954 Barrels E reported the first case of leukemia patients undergoing the intravenous pyelography postoperative acute renal failure, CIN into sight. European Urology Association (ESUR) which is defined as the exclusion of other influences, within three days after the use of contrast agents, the occurrence of acute exacerbation of renal failure, a 25% increase in serum creatinine (Scr) or 0.5mg/d1 (44.2mol / 1) diagnostic criteria. Usually very low incidence of CIN is about 0.6-2.3%, greatly increased prevalence of CIN in patients undergoing PCI surgery, however, reported in the literature up to 14.5%. Contrast induced nephropathy, extend the duration of hospitalization, severe cases may even require renal replacement therapy, and increased mortality rate, and has become the third leading cause of hospital-acquired renal insufficiency. Currently, the accepted definition of contrast-induced nephropathy more people: Contrast-induced nephropathy (contrast induced nephropathy CIN), usually considered to be other reasons could explain the acute renal dysfunction after contrast injection, serum creatinine (Scr) than angiography before 25% increase or Scr increase 44.2umol / L (5 mg / L) as diagnostic criteria. CIN the multi reported in percutaneous coronary heart disease interventional treatment of patients, there are a few reports in patients with peripheral vascular intervention. Treatment of percutaneous coronary intervention (Percutaneous coronary intervention, PCI) is the primary means of revascularization of patients with acute coronary syndrome (Acute coronary syndrome, ACS), and its efficacy, prognosis faster wound small adverse low outstanding advantages, more and more widely used in clinical. Although some patients had decreased kidney function appears just after the use of a contrast agent, but often accept PCI of more elderly patients with diabetes, chronic renal insufficiency and multivessel disease risk factors, the use of contrast agents CIN The risk is significantly higher. Once CIN PCI postoperative mortality, hospital mortality, and long-term mortality was significantly increased. Therefore, in the process of arterial interventional procedures, the application of contrast agents should be fully aware of the risk of CIN intravascular use of contrast agents in patients with preoperative, postoperative renal changes early judgment is very important. Currently reflect glomerular filtration function in clinical indicators such as blood urea nitrogen (BUN), Scr, endogenous creatinine clearance rate (Ccr) has certain limitations, and to varying degrees by some renal or extrarenal factors interference. Serum creatinine factors: sex, age, body surface area, drugs, bilirubin, glucose, ascorbic acid, and determination methods, muscle mass, the intake of the meat, the level of in vivo metabolism, cephalosporin antibiotics. Is a more sensitive indicator of glomerular filtration function Ccr Ccr dropped to 80% of the normal value, BUN and Scr still in the normal range. Ccr also have limitations, interference by a number of factors: such as renal tubular secretion of a small amount of creatinine, will make the determination of creatinine in urine by under interference. Tubular excretion of creatinine can increase when serum creatinine concentration was significantly higher than the actual measured glomerular filtration rate. Investigator F12 receptor blockers cimetidine to prevent renal tubular secretion, in order to improve the accuracy of the measurement; urine collection time is not recorded accurately, some urine loss, especially the elderly prostatic hyperplasia the bladder urinary retention time: as well as urine stored improperly, especially at high temperatures, changes in uric acid to creatinine. These factors may affect the authenticity of the glomerular filtration rate (GFR), Ccr complex operation, and should not be widely promoted. Clinical based solely on serum creatinine to as CIN evaluation, but Scr by the exogenous creatinine intake of individual differences affect the obvious and only three days to accept the average hospital stay of patients for coronary angiography, in such a short period of time by monitoring Scr forecast, both can not describe the whole picture of disease, misdiagnosis may cause CIN CIN occurred, nor why when clinical intervention to provide information for decision-making, should find a more sensitive and reliable indicators reflect early CIN. Interleukin-6 (IL-6) is one of the core members of the interleukin family, is secreted by mononuclear cells, endothelial cells and other cells produce cytokines. It is involved in acute inflammation, tissue injury and immune response to a variety of biological processes and is a central regulator of the inflammatory response, is the most important early mediator of kidney acute phase protein synthesis reaction and participate in the body to various adjustment important factor. Kidney inherent cells are able to secrete IL-6; currently that IL-6 and the occurrence of kidney disease and the development of a close relationship. The normal low levels of IL-6 expression in human kidney, acute kidney injury, in the course of the disease, endothelial cell damage, IL-6 directly or indirectly involved in inflammation and stress response and abundantly expressed in the blood measured a. Wei Min, Zhang Yan, observed severe burns the early rat kidney cells of IL-6 expression, the results show after injury 30min, immunohistochemistry and in situ hybridization showed that IL-6 expression increased, 2h-24h after injury significantly enhanced positive or strongly positive; 72 hours after injury, expression decreased gradually. Studies have shown that blood IL-6 abnormally high levels of blood IL-6 can be used as a monitoring kidney disease reversibility activity index in kidney patients. However, the IL-6 used in the detection of acute kidney injury after the use of contrast agents in the elderly rarely reported. Two hours if they can be used in patients with intravascular contrast agent that can be detected expression significantly enhanced early detection of CIN patients, to reduce the rate of missed diagnosis of CIN, and CIN patients have been treated in a timely manner in the shortest possible time is a very biological indicator of the prospects for the early prediction of changes in renal function. Cystatin C (CysC) is a research hotspot in recent years, is the ideal measure the endogenous marker of GFR. Foreign Hoek and many scholars believe that CysC | more sensitive than creatinine accurately reflect the GFR. Creatinine usually a decrease of about 50% in GFR only increase, and cystatin C in the serum creatinine concentration is not changed, i.e. the so-called \The CysC gene belongs to the housekeeping gene, almost all nucleated cells stably expressing non-tissue-specific. CysC is a non-glycosylated basic protein, small molecular weight, positively charged, is not bound to plasma proteins, it is able to pass freely through the glomerular filtration membrane, and almost completely in proximal tubule reabsorption reabsorption after The complete catabolism, no longer go back to the blood circulation. Tubular not secrete CysC, kidney is the removal of circulating the CysC the only organ serum CysC concentration is determined primarily by the GFR, CysC from muscle, the impact of factors such as age, sex, diet, inflammation, tumor, so is the determination of the ideal GFR endogenous markers. Clinical CysC as a routine examination of the renal, but already more concentrated in the diagnosis of typical glomerular and tubular disease, not much literature CysC as a biochemical marker of CIN. A recent children's heart surgery prospective study results show that the occurrence of AKI serum CysC levels after 12 hours increased application CysC interventional procedures in the diagnosis of elderly heart CNI research remains to be further studied. Therefore, the purpose of this study is to evaluate CysC clinical significance of IL-6 in the early prediction of contrast-induced nephropathy in which clinicians to understand the changes in renal function in elderly patients after PCI, then for early clinical diagnosis and prevention of acute kidney damage maximum protection of renal function provide new clues, and the the CysC joint IL-6 alternative Scr as an ideal marker for early diagnosis of CIN explore. Objective To observe the line coronary intervention in the elderly preoperative and postoperative serum creatinine select crowd postoperative contrast-induced nephropathy, never occurred CIN cases selected C1N group of patients as a control group of the same number of cases, monitoring in different time point serum interleukin 6, cystatin C changes to clarify whether through monitoring of serum interleukin-6, cystatin C early diagnosis of CIN. Objects and methods. Objects and methods to collect the 2009.9-2010.8 data of elderly patients with ACS undergoing PCI in our hospital of 190 cases. Contrast-induced nephropathy (CIN) traditional definition of elevated 0.5mg/d1 or compared to baseline values ??(ie, serum creatinine levels after 24-48h increased by 25%, and the exclusion of the other kidney damage factors of heart failure, serious arrhythmias). As cases of CIN CIN, the CIN cases selected C1N group of patients with the same number of cases as the control group, the control group from the gender, age, blood sugar, blood pressure, basic Scr, Ccr, the amount of contrast agent and intraoperative never happened 48 hours after input pair. Enzymatic determination of all enrolled patients with preoperative and postoperative 12 hours, 24 hours, 48 ??hours, serum creatinine values. Specimens from the patients before and after 2 hours, 8 hours, 24 hours serum samples, to detect immune turbidimetry CIN patients serum cystatin C values ??occurred, serum cystatin C values ??between different time points in the comparison group and corresponding time points serum cystatin C values ??compared with non-CIN group. Specimens from patients before and after 2 hours, 8 hours, 24 hours serum samples, serum IL-6 values ??ELISA method, the comparison group at different time points between the serum IL-6 values, and non-CIN group time point serum IL-6 values ??compared. Statistical methods Measurement data were expressed as mean ± standard deviation; SPSS13.0 software for statistical analysis. Between the two groups at different time points of IL-6.CysC the concentration using a repeated measures analysis of variance, the same group between preoperative and postoperative time points using paired t-test between the two groups at the same time point comparing the use of independent sample t test. P lt; 0.05 shows that the difference was statistically significant. Results of 190 patients, the occurrence of the CIN 20 patients, the rate was 10.53%. CIN group, two hours after the use of contrast agents, increased serum IL-6 compared with the preoperative eight hours serum IL-6 levels were significantly increased 24h after serum interleukin-6 level compared with postoperative 8h significantly elevated [0h / (7.21 ± 3.49), 2h / (8.43 ± 4.23), 8h / (16.31 ± 4.41), 24h / (34.08 ± 4.46), 8h.24h 0h comparison P = 0.000]. CIN group compared with non-CIN group, after 8h, 24h compared with non-CIN group corresponding time points significantly higher [8h / (16.31 ± 4.41) than (7.50 ± 2.86), P = 0.000; 24h / (34.08 ± 4.46) than (8.24 ± 3.08), P = 0.000]. ,(1.384 ± 0.10), P = 0.000]. Conclusions In elderly patients with ACS after PCI, serum IL-6 after surgery 8h of CysC significantly higher 24h after time earlier rise in serum creatinine, and can be combined as elderly ACS patients after PCI occurred CIN early predictor .

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