摘要
目的观察脓毒症患者细胞因子的表达水平及其对预后的影响。方法回顾性分析2020年1月至2022年12月郑州大学第一附属医院重症监护病房(ICU)收治的脓毒症患者的临床资料,包括性别、年龄以及入ICU 24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、血常规、降钙素原(PCT)、C-反应蛋白(CRP)、细胞因子水平〔白细胞介素(IL-2、IL-4、IL-6、IL-10、IL-17)、肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)〕,并追踪患者28 d预后情况。将患者按预后分为生存组和死亡组,比较不同预后两组脓毒症患者临床资料的差异。采用二元Logistic回归分析影响脓毒症患者预后的独立危险因素,并绘制受试者工作特征曲线(ROC曲线)评价各危险因素对脓毒症患者预后的预测价值。结果①研究共纳入脓毒症患者227例,生存组168例(生存率74.0%),死亡组59例(病死率26.0%)。死亡组与生存组年龄(岁:55.97±2.13比54.67±1.11)、性别(男性:71.2%比57.1%)比较差异均无统计学意义(均P>0.05),说明两组基线资料具有可比性。②死亡组APACHEⅡ(分:19.37±0.99比14.88±0.61,P<0.001)、PCT(μg/L:12.39±2.94比4.14±0.90,P<0.001)均明显高于生存组,而血小板计数〔PLT(×10^(9)/L):144.75±12.50比215.99±11.26,P=0.001〕、血小板压积〔(0.14±0.01)%比(0.19±0.01)%,P=0.001〕均明显低于生存组。③死亡组IL-6明显高于生存组(ng/L:577.66±143.16比99.74±33.84,P<0.001),而死亡组其余细胞因子IL-2、IL-4、IL-10、TNF-α、IFN-γ、IL-17与生存组比较差异均无统计学意义〔IL-2(ng/L):2.44±0.38比2.63±0.27,P=0.708;IL-4(ng/L):3.26±0.67比3.18±0.34,P=0.913;IL-10(ng/L):33.22±5.13比39.43±2.85,P=0.262;TNF-α(ng/L):59.33±19.21比48.79±29.87,P=0.839;IFN-γ(ng/L):6.69±5.18比1.81±0.16,P=0.100;IL-17(ng/L):2.05±0.29比2.58±0.33,P=0.369〕。④二元Logistic回归分析显示,APACHEⅡ评分和IL-6均是影响脓毒症患者预后的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为1.050(1.008~1.093)和1.001(1.000~1.002),P值分别为0.019和0.026〕。⑤ROC曲线分析显示,APACHEⅡ评分和IL-6对脓毒症患者预后均有一定的预测价值,ROC曲线下面积(AUC)分别为0.754(95%CI为0.681~0.827)和0.592(95%CI为0.511~0.673),P值分别为<0.001和0.035;当APACHEⅡ的最佳截断值为16.50分时,其敏感度为72.6%,特异度为69.9%;当IL-6的最佳截断值为27.87 ng/L时,其敏感度为67.2%,特异度为52.8%。结论APACHEⅡ评分、IL-6水平对脓毒症患者的预后均有一定预测价值,APACHEⅡ评分、IL-6水平越高,脓毒症患者死亡概率越大。
Objective To observe the expression level of cytokines in patients with sepsis and its effect on prognosis.Methods The clinical data of sepsis patients admitted to the intensive care unit(ICU)of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were analyzed retrospectively,including gender,age,and acute physiology and chronic health evaluationⅡ(APACHEⅡ),blood routine,procalcitonin(PCT),C-reactive protein(CRP),and cytokines levels[interleukins(IL-2,IL-4,IL-6,IL-10,IL-17),tumor necrosis factor-α(TNF-α),and interferon-γ(IFN-γ)]within 24 hours of admission to ICU.The 28-day prognosis of the patients was followed up.The patients were divided into survival group and death group according to the prognosis.The clinical data between the two groups of sepsis patients with different prognosis were compared.Binary Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of patients with sepsis,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the prognosis of patients with sepsis.Results①A total of 227 patients with sepsis were enrolled,including 168 patients in the survival group(survival rate 74.0%)and 59 patients in the death group(mortality 26.0%).There were no significant differences in age(years old:55.97±2.13 vs.54.67±1.11)and gender(male:71.2%vs.57.1%)between the death group and the survival group(both P>0.05),indicating that the baseline data of the two groups were comparable.②The APACHEⅡ(19.37±0.99 vs.14.88±0.61,P<0.001)and PCT(μg/L:12.39±2.94 vs.4.14±0.90,P<0.001)in the death group were significantly higher than those in the survival group,while the platelet count[PLT(×10^(9)/L):144.75±12.50 vs.215.99±11.26,P=0.001]and thrombocytocrit[(0.14±0.01)%vs.(0.19±0.01)%,P=0.001]were significantly lower than those in the survival group.③The level of IL-6 in the death group was significantly higher than that in the survival group(ng/L:577.66±143.16 vs.99.74±33.84,P<0.001).There were no statistically significant differences in other cytokines,IL-2,IL-4,IL-10,TNF-α,IFN-γand IL-17 between the death group and the survival group[IL-2(ng/L):2.44±0.38 vs.2.63±0.27,P=0.708;IL-4(ng/L):3.26±0.67 vs.3.18±0.34,P=0.913;IL-10(ng/L):33.22±5.13 vs.39.43±2.85,P=0.262;TNF-α(ng/L):59.33±19.21 vs.48.79±29.87,P=0.839;IFN-γ(ng/L):6.69±5.18 vs.1.81±0.16,P=0.100;IL-17(ng/L):2.05±0.29 vs.2.58±0.33,P=0.369].④Binary Logistic regression analysis showed that APACHEⅡand IL-6 were independent risk factors affecting the prognosis of patients with sepsis[odds ratio(OR)and 95%confidence interval(95%CI)were 1.050(1.008-1.093)and 1.001(1.000-1.002),P values were 0.019 and 0.026,respectively].⑤ROC curve analysis showed that APACHEⅡand IL-6 had certain predictive value for the prognosis of patients with sepsis,the area under the ROC curve(AUC)was 0.754(95%CI was 0.681-0.827)and 0.592(95%CI was 0.511-0.673),P values were<0.001 and 0.035,respectively.When the optimal cut-off value of APACHEⅡwas 16.50 score,the sensitivity was 72.6%and the specificity was 69.9%.When the optimal cut-off value of IL-6 was 27.87 ng/L,the sensitivity was 67.2%and the specificity was 52.8%.Conclusion APACHEⅡscore and IL-6 level have certain predictive value for the prognosis of patients with sepsis,the higher APACHEⅡscore and IL-6 level,the greater the probability of death in patients with sepsis.
作者
李平娜
杨宏富
崔秋敏
马宁
刘启龙
孙小鸽
孙荣青
Li Pingna;Yang Hongfu;Cui Qiumin;Ma Ning;Liu Qilong;Sun Xiaoge;Sun Rongqing(Department of Intensive Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第12期1250-1254,共5页
Chinese Critical Care Medicine
基金
河南省医学科技攻关计划(联合共建)项目(LHGJ20190213)。
作者简介
通信作者:孙荣青,Email:rongqing.sun@126.com。
