卒中相关感染患者外周血皮质醇、IFN-γ、IL-4和IL-10的变化

Changes of peripheral blood cortisol,IFN-γ,IL-4 and IL-10 levels in patients with stroke-associated infection

目的探讨卒中相关感染(SAI)患者血清皮质醇及血浆γ干扰素(IFN-γ)、白细胞介素4(IL-4)、白细胞介素10(IL-10)水平的变化。方法连续收集发病24 h内入院的急性脑梗死或脑出血患者共85例,根据入院7 d内有无感染将患者分为感染组(n=29)和非感染组(n=56)。分别于入院第1天和第7天,采用化学发光法测定血清皮质醇水平,双抗体夹心酶联免疫反应测定血浆IFN-γ、IL-4和IL-10水平。采用多因素非条件逐步Logistic回归分析法分析SAI的易感因素。结果入院第1天和第7天,感染组皮质醇、IL-4和IL-10水平均显著高于非感染组(P<0.05),IFN-γ水平显著低于非感染组(P<0.05)。入院第1天,相关性分析显示,皮质醇与IFN-γ水平呈负相关(r=-0.299,P=0.024),与IL-4、IL-10水平呈正相关(r=0.298,P=0.040;r=0.306,P=0.026)。Logistic回归分析显示,入院第1天皮质醇水平升高是SAI发生的独立危险因素(OR=0.903,95%可信区间为0.816～1.000,P=0.05)。结论皮质醇、IFN-γ、IL-4和IL-10在SAI发生中起重要作用。

Objective To investigate the changes of peripheral blood cortisol,interferon-γ(IFN-γ),interleukin-4(IL-4) and interleukin-10(IL-10) levels in patients with stroke-associated infection(SAI). Methods Eighty-five patients with acute cerebral infarction or cerebral hemorrhage admitted to hospital within 24 h after symptom onset were selected.Patients were divided into infection group(n=29) and non-infection group(n=56) according to the infection status within 7 d after admission.Serum cortisol levels were measured by chemiluminescence method,and plasma IFN-γ,IL-4 and IL-10 levels were determined by ELISA on the first day and seventh day after admission.Stepwise Logistic regression analysis was adopted to explore the correlation factors for SAI. Results On the first day and seventh day after admission,the levels of serum cortisol and plasma IL-4 and IL-10 in infection group were significantly higher than those in non-infection group(P<0.05),while the level of plasma IFN-γ in infection group was significantly lower than that in non-infection group(P<0.05).On the first day after admission,the correlation analysis indicated that there was a negative correlation between level of serum cortisol and level of plasma IFN-γ(r=-0.299,P=0.024),and there was a positive correlation between level of serum cortisol and levels of plasma IL-4 and IL-10(r=0.298,P=0.040;r=0.306,P=0.026).Logistic regression analysis revealed that increased level of serum cortisol on the first day after admission was an independent risk factor for SAI(OR,0.903;95% confidence interval,0.816-1.000;P=0.05). Conclusion Cortisol,IFN-γ,IL-4 and IL-10 may play important roles in the development of SAI.