尿TNF-a与IL-6在急性肾损伤早期诊断中的价值

目的 观察肿瘤坏死因子（TNF-a）与白细胞介素-6（IL-6）在急性肾损伤（acute kidney injury,AKI）患者尿液中的变化,探讨其在AKI早期诊断中的意义.方法 收集2009年1月-2011年2月我院肾内科及ICU住院的AKI患者、终末期肾脏病（end stage renal disease,ESRD）患者及健康对照者的血清、尿液及临床表现等资料.按照RIFLE标准,将住院治疗患者分为轻度AKI组50例、中重度AKI组50例;另外,危重病组30例、ESRD组60例和健康对照组60例;采用ELISA方法检测尿TNF-a与IL-6,评价尿TNF-a与IL-6在AKI早期临床诊断中的价值和意义.结果 轻度AKI组、中重度AKI组、ESRD组、危重组和健康对照组的尿TNF-a分别是（36.5±11.5）pg/ml、（63.5±15.7）pg/ml、（14.8±3.2）pg/ml、（15.9±3.5）pg/ml和（15.3±3.6）pg/ml,尿IL-6分别是（15.2±4.8）pg/ml、（18.6±6.2）pg/ml、（6.8±1.1）pg/ml、（7.2±1.2）pg/ml、（6.4±0.8）pg/ml.与健康对照组及ESRD组和危重病组比较,轻度AKI组和中重度AKI组的尿TNF-a与IL-6均有明显升高,差异有显著性（P＜0.05）：其中,中重度AKI组较轻度AKI组尿TNF-a与IL-6升高更明显,差异有显著性（P＜0.05）：危重病组、ESRD组尿TNF-a与IL-6与健康对照组比较差异有显著性（P＞0.05）.结论 AKI发生时,检测尿中TNF-a与IL-6有助于AKI的早期临床诊断.

The significance of TNF-a and IL-6 in the early diagnosis of acute kidney injury

Objective To investigate the significance of TNF-a and IL-6 changes in urine in patients with acute kidney injury(AKI).Methods Clinical presentations, urine and serum samples were collected in patients admitted to our hospital from January 2009 to February 2011 with slight AKI (50 cases), medium-severe AKI (50 cases), and critical illness patients(30 cases), end stage renal disease (ESRD, 60cases) based on the RIFLE criteria. Urine and serum samples were also collected from 60 healthy controls. Urinary TNF-a and IL-6 were assayed by ELISA ,the correlation between TNF-a and IL-6 in urine was analyze, and the sensitivity and specificity of urinary TNF-a and IL-6 in the early diagnosis of AKI were evaluated. Results Urinary TNF-a and IL-6 increased significantly in patients with slight and medium-severe AKI,as compared with those in ESRD patients and normal controls (P＜0.05). Urinary TNF-a and IL-6 were higher in patients with medium-severe AKI than in slight AKI (P＜0.05). No statistical significant difference was found in urinary TNF-a and IL-6 between critical illness patients, ESRD patients and healthy eontrols (P＞ 0.05). Conclusion Urinary TNF-a and IL-6 are useful markeea for the early diagnosis of AKI.