| Objective: (1) To explore postoperative renal injury and the probable mechanism by detecting the levels of serum Cystatin C(CysC), urinary N-acetyl-beta-D-glucosaminidase(NAG), and serum Cr, BUN, tumor necrosis factor-alpha (TNF-α) and interleukin-6(IL-6) in infants with congenital heart disease before and after cardiopulmonary bypass(CPB);(2) Pretreated with Astragalus injection and then the concentrations of the above markers were measured to explore whether there is therpeutic effect of Astragalus injection against renal injury and analysis its probable mechanism in infants after CPB.Methods: (1) 40 infants were randomly assigned to the test group or the control group from Oct 2009 to Jul 2010, twenty in each group. Astragalus injection(at the dose of 2ml/kg) was added in the perfusion fluid before giving to infants in the test group before bypass,while the normal saline of the same volume was added in the perfusion fluid before giving to infants in the control group before bypass;(2) Arterial blood and urine were collected(2~3ml) at the following time points: before bypass(T1), by the end of the surgery(T2), 2h after surgery(T3), 6h after surgery(T4), and 24h after surgery(T5). The concentrations of serum TNF-α, IL-6, CysC and urinary NAG were detected with ELISA;(3) Serum Cr and BUN in infants were detected with conventional biochemistry technique before and after operation 2h;(4) Linear correlation analysis was performed between inflammatory cytokines and renal function markers.Results: (1) Serum Cr and BUN of all infants were normal before and after operation 2h, there were no obvious changes before and after surgery(P>0.05); There was not significant difference on CysC in control group compared with T1(P>0.05), but the level of CysC in the test group was lower than that of the control group at T2(P<0.05); The urinary NAG levels increased significantly in the control group after surgery(P<0.05), and it was obviously lower than that of the control group at the time points of T2, T3 and T4(P<0.05);(2) The cases of infants with Cr>97μmol/L or BUN>8.2mmol/L were 0 in all infants before and after surgery 2h; The cases of infants with NAG>14.37U/L were 0 and 11 before and after surgery 2h respectively; The cases of infants with CysC>1.25mg/L were 4 and 7 before and after surgery 2h, respectively. The positive rate of renal injury detected by NAG was significantly higher than that by Cr or BUN at T3(χ2 =12.862 P<0.01), The positive rate of renal injury detected by CysC was also obviously higher than that by Cr or BUN at T3(χ2 =5.665 P<0.05);(2) Compared with T1, TNF-αelevated significantly in the control group at the time points of T2, T3 and T4(P<0.05), and TNF-αin the test group were lower than that in the control group at T2, T3, T4 and T5(P<0.01); Compared with T1, IL-6 also increased significantly in the control group at T2(P<0.05), and IL-6 in the test group also was lower than that in control group at T3(P<0.01);(3) NAG was positively correlated with TNF-αand IL-6(r=0.317, 0.308 both P<0.01); There was positive correlation between CysC and IL-6(r=0.255 P<0.05).Conclusions: (1) CysC and NAG may be more sensitive than Cr or BUN on reflecting the change of renal function in infants with congenital heart disease;(2) The impairment of renal tubular function was observed in infants after cardiac surgery with cardiopulmonary bypass but there was not obvious injury to glomerular filtration function, it is inferred that renal injury may be correlated with the increases in the concentrations of TNF-αand IL-6;(3) Application of Astragalus injection protected renal tubular function and improved glomerular filtration function; Astragalus injection could reduce the peak concentrations of TNF-αand IL-6 after CPB. It is inferred that there may be correlation between protection for renal function and inhibition of increases of TNF-αand IL-6 from Astragalus injection in infants with congenital heart disease. |
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