Chen Zujun, Hu Zhenliang, Hu Yiqing, Sheng Yixuan, Li Yuan, Song Jiangping
State Key Laboratory of Cardiovascular Disease, Department of Cardiac Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Front Physiol. 2020 Nov 10;11:587204. doi: 10.3389/fphys.2020.587204. eCollection 2020.
Acute kidney injury (AKI) occurs in about 30% of patients with cardiac surgery, but the pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) remains unclear and there are no predictive biomarkers or diagnostic criteria specific for CSA-AKI beyond the general clinical variables for AKI like serum creatinine (SCr).
We measured the plasma levels of 48 cytokines within 24 h after cardiac surgery in a total of 306 adult patients including 204 with and 102 without AKI, and then evaluated the diagnostic efficacy of these cytokines for the development of CSA-AKI via ANOVA and Pearson correlation analysis. Among these 48 cytokines, 20 of them were significantly different in the AKI patients compared with the non-AKI patients. In particularly, 13 cytokines displayed tremendous changes with the < 1E. Moreover, 10 of the 48 cytokines in the plasma were significantly different among the patients with different stages of AKI. Specifically, 6 cytokines exhibited immense differences with the < 1E. Additionally, 7 of the 48 cytokines have the correlation coefficient of > 0.5 with the postoperative changes of SCr after cardiac surgery.
Taken all the results together, IFN-γ and SCGF-β were the most relevant two cytokines that were not only remarkably changed in adult CSA-AKI patients during the first 24 h after cardiac surgery, but also significantly correlated with the postoperative changes of SCr after cardiac surgery. Therefore, IFN-γ and SCGF-β might be novel predictive plasma biomarker, as well as potential therapeutic targets specific for adult CSA-AKI.
急性肾损伤(AKI)发生在约30%的心脏手术患者中,但心脏手术相关急性肾损伤(CSA-AKI)的发病机制仍不清楚,除了AKI的一般临床变量如血清肌酐(SCr)外,尚无针对CSA-AKI的预测生物标志物或诊断标准。
我们在心脏手术后24小时内测量了总共306例成年患者(包括204例发生AKI和102例未发生AKI)的48种细胞因子的血浆水平,然后通过方差分析和Pearson相关分析评估这些细胞因子对CSA-AKI发生的诊断效能。在这48种细胞因子中,其中20种在AKI患者与非AKI患者中存在显著差异。特别是,13种细胞因子显示出巨大变化,其P<1E。此外,血浆中48种细胞因子中的10种在不同AKI阶段的患者中存在显著差异。具体而言,6种细胞因子表现出巨大差异,其P<1E。另外,48种细胞因子中的7种与心脏手术后SCr的术后变化的相关系数>0.5。
综合所有结果,IFN-γ和SCGF-β是最相关的两种细胞因子,它们不仅在成年CSA-AKI患者心脏手术后的最初24小时内有显著变化,而且与心脏手术后SCr的术后变化显著相关。因此,IFN-γ和SCGF-β可能是新型的预测性血浆生物标志物,也是成年CSA-AKI特有的潜在治疗靶点。