血清白细胞介素联合监测在脓毒症严重程度及预后评估中的作用研究

Role of combined monitoring on serum interleukin in the assessment of septic severity and prognosis

目的:分析脓毒症患者白细胞介素-1(interleukin-1,IL-1)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、白细胞介素-10(interleukin-10,IL-10)在脓毒症患者不同严重程度及预后中的特点,为评估其病情严重程度及预后提供参考。方法:选择2016年3月至2017年8月收入重庆医科大学附属第一医院重症医学科的71名脓毒症患者为研究对象。脓毒症患者按病情严重程度分为脓毒症组(37例)和脓毒性休克组(34例);根据28 d转归分为生存组(58例)和死亡组(13例)。记录患者入重症监护室(intensive care unit,ICU)时序贯器官衰竭评分(sequential organ failure assessment,SOFA)与急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ),检测血C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、IL-1、IL-4、IL-6及IL-8。比较脓毒症组、脓毒性休克组间上述指标的不同,并应用受试者工作特征曲线(receiver operating characteristic,ROC)分析上述指标对患者预后评估的临床价值。结果:脓毒性休克组患者SOFA评分(P=0.001)、APACHEⅡ评分(P=0.001)、CRP(P=0.019)、IL-1(P=0.001)、IL-6(P=0.004)、IL-8(P=0.001)及IL-10(P=0.001)皆比脓毒症组高,差异皆具有统计学意义(均P<0.05)。脓毒性休克组和脓毒症组在血清PCT水平上没有统计学差异(P=0.325)。按照28 d预后情况将研究对象分为生存组和死亡组,分析结果显示死亡组中SOFA评分(P=0.001)、APACHEⅡ(P=0.001)、IL-1(P=0.037)及IL-8(P=0.035)明显高于生存组,差异均具有统计学意义(均P<0.05)。而CRP(P=0.544)、IL-6(P=0.586)、IL-10(P=0.676)的差异在评估脓毒症患者预后的比较中没有统计学意义(P>0.05)。根据ROC曲线分析IL-1[曲线下面积(area under curve,AUC)=0.657]、IL-8(AUC=0.689)能反映患者预后,但预测价值低于SOFA评分(AUC=0.845)、APACHEⅡ评分(AUC=0.834),而联合监测IL-1与IL-8(AUC=0.704)较单独监测对预后评估的价值更高。结论:CRP、IL-1、IL-6、IL-8及IL-10和脓毒症严重程度具有相关性,对判断脓毒症严重程度具有潜在价值。联合监测IL-1、IL-8能够反映脓毒症患者的预后。

Objective:To analyze the characteristics of interleukin-1(IL-1),interleukin-6(IL-6),interleukin-8(IL-8) and interleukin-10(IL-10) in patients with different septic severity as well as its prognosis,providing clinical references to assess the severity and outcome of sepsis. Methods:A total of 71 septic patients in our department from March 2016 to August 2017 were enrolled. On the basis of severity of sepsis,patients were divided into the sepsis group(n=37) and the septic shock group(n=34). In addition,they were divided into the survival group(n=58) and the death group(n=13) according to the 28-day outcome. Sequential organ failure assessment(SOFA) and acute physiology and chronic health evaluationⅡ(APACHEⅡ) were recorded when patients entered the intensive care unit(ICU). Procalcitonin(PCT),c-reactive protein(CRP),IL-1,IL-4,IL-6 and IL-8 were measured. The difference of above indexes between the sepsis group and the septic shock group was compared,and the clinical value of these indexes in evaluating the prognosis of patients was analyzed by applying the receiver operating characteristic(ROC). Results:Scores of SOFA(P =0.001),APACHE Ⅱ(P =0.001),CRP(P =0.019),IL-1(P =0.001),IL-6(P =0.004),IL-8(P=0.001) and IL-10(P=0.001) in the septic shock group were significantly higher than those in the sepsis group,all differences with statistical significances(P<0.05). Serum PCT level(P=0.325) between the septic shock group and the sepsis group had no significant difference. According to the 28-day outcome,results showed that scores of SOFA(P=0.001),APACHEⅡ(P=0.001),IL-1(P=0.037) and IL-8(P=0.035) in the death group were significantly higher than those in the survival group(P<0.05),all differences with statistical significances. However,CRP(P=0.544),IL-6(P=0.586) and IL-10(P=0.676) in the evaluation of prognosis of septic patients had no significant differences. According to ROC curve,IL-1(area under curve,AUC=0.657) and IL-8(AUC=0.689) was able to reflect the prognosis of patients,but its predictive value was lower than the SOFA score(AUC=0.853) and the APACHEⅡ score(AUC=0.843).Combined monitoring IL-1 and IL-8(AUC=0.704) had higher value to assess the prognosis than individual monitoring. Conclusion:The CRP,IL-1,IL-6,IL-8 and IL-10 have correlation with sepsis severity,which are of potential value in judging the severity of sepsis. Combined monitoring IL-1 and IL-8 can reflect the prognosis of sepsis patients.