不同炎症因子对急性冠脉综合征患者介入治疗术后发生造影剂诱导的急性肾损伤的影响-东南大学学报医学版

不同炎症因子对急性冠脉综合征患者介入治疗术后发生造影剂诱导的急性肾损伤的影响

作者：王晨宇¹ 鄢高亮¹ 2 王栋¹ 2 乔勇¹ 2 秦雨晗¹ 2 马根山¹ 2 汤成春¹ 2

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院心血管内科, 江苏南京 210009

分类号：R654.2;R692

出版年·卷·期（页码）：2024·43·第六期（811-821）

摘要：

目的:探讨血清中不同炎症因子对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗术(PCI)后发生造影剂诱导的急性肾损伤(CI-AKI)的预测价值。方法:连续入选2023年1月至12月在东南大学附属中大医院心血管内科行PCI治疗的患者464例,依据是否发生CI-AKI将患者分成CI-AKI组(n=72)和非CI-AKI组(n=392),纳入的炎症因子包括IL-2、IL-4、IL-6、IL-10、IL-17、TNF-α、γ-IFN。应用多因素Logistic回归探讨CI-AKI的危险因素,采用受试者工作特征(ROC)曲线评估炎症因子对CI-AKI的预测性能。结果:CI-AKI组患者血清中IL-2、IL-6、IL-17、γ-IFN水平显著高于非CI-AKI组(P＜0.05),IL-10水平显著低于非CI-AKI组(P＜0.05)。多因素Logistic回归分析显示IL-2≥0.24 pg·mL^-1、IL-6≥5.37 pg·mL^-1、 IL-10<1.24 pg·mL^-1、 IL-17≥0.49 pg·mL^-1、γ-IFN≥0.78 pg·mL^-1是发生CI-AKI的危险因素。在纳入2~3个炎症因子的联合预测模型中,联合IL-6+IL-10、IL-2+IL-17+γ-IFN的组合5[曲线下面积(AUC)=0.688,95%CI:0.613~0.755]、组合16(AUC=0.730,95%CI:0.683~0.785)具有较高的 AUC,纳入7种炎症因子的组合22(AUC=0.773,95%CI:0.718~0.826)预测效能最好,可显著改善Mehran评分预测CI-AKI的AUC(P＜0.05)。结论:血清中不同炎症因子水平与CI-AKI的发生有关,纳入IL-2、IL-4、IL-6、IL-10、IL-17、TNF-α、γ-IFN的炎症因子联合预测模型对ACS患者PCI术后发生CI-AKI具有预测价值。

Objective: To investigate the predictive value of various serum inflammatory cytokines for contrast-induced acute kidney injury(CI-AKI) in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods: A total of 464 patients who underwent PCI in Zhongda Hospital, Southeast University from January 2023 to December 2023 were consecutively enrolled. Patients were divided into the CI-AKI group(n=72) and the non-CI-AKI group(n=392) based on the occurrence of CI-AKI. Inflammatory cytokines assessed were IL-2,IL-4,IL-6,IL-10,IL-17,TNF-α and γ-IFN. Multivariate Logistic regression was used to identify risk factors for CI-AKI, and ROC curves were utilized to evaluate the predictive value of cytokines for CI-AKI. Results: Serum IL-2,IL-6,IL-17 and γ-IFN levels in the CI-AKI group were significantly higher than those in the non-CI-AKI group(P<0.05), while IL-10 level was significantly lower in the CI-AKI group compared to the non-CI-AKI group(P<0.05). Multivariate Logistic regression showed that IL-2≥0.24 pg·mL^-1, IL-6≥5.37 pg·mL^-1, IL-10<1.24 pg·mL^-1, IL-17≥0.49 pg·mL^-1 and γ-IFN≥0.78 pg·mL^-1were significantly associated with CI-AKI. In the multivariate predictive model incorporating 2-3 inflammatory cytokines, combination 5[area under the curve(AUC)=0.688, 95%CI:0.613-0.755] and combination 16(AUC=0.730, 95%CI:0.683-0.785) which included IL-6+IL-10 and IL-2+IL-17+γ-IFN demonstrated higher AUC. The combination 22 involving all 7 inflammatory cytokines exhibited the best predictive performance(AUC=0.773, 95%CI:0.718-0.826), significantly enhancing the AUC of the Mehran score for predicting CI-AKI(P<0.05). Conclusion: Serum levels of various inflammatory cytokines are associated with the development of CI-AKI, and the combined predictive models including inflammatory cytokines IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and γ-IFN have potential prognostic value for predicting CI-AKI in patients with ACS undergoing PCI.

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