外周血趋化因子水平对新型甲流H1N1患者临床转归的预测价值

Prognostic values of chemokines in different clinical outcomes of influenza A （H1N1）-infected patients

目的探讨新型甲流H1N1患者外周血趋化因子水平对临床预后转归的预测价值。方法以2009年4月至2010年1月间经北京佑安医院收治的新型甲流H1N1患者60例为研究对象，分为轻症组（32例）、重症痊愈组（16例）、死亡组（12例）。Luminex技术检测外周血清中趋化因子CXCL8、CCL10、CCL2、CCL3、CCIA、CCL5及CCL11水平。结果新型甲流H1N1死亡组外周血CXCL8、CCL2及CCL10水平明显高于重症组及轻症组，组间比较差异具有统计学意义，P值分别为0．001、〈0．0001及0．027。CCL2、CXCL8水平预测新型甲流H1N1感染死亡的阈值分别为45．99ng／L（灵敏性为100％，特异性为89．58％）、59．75ng／L（灵敏性为75％，特异性为95．83％）。结论新型甲流H1N1重症感染者外周血中趋化因子水平明显增加，CXCL8、CCL2在死亡组增加尤为明显，可作为新型甲流H1N1感染不良预后预测指标。

Objective To analyze the prognostic values of chemokines in different clinical outcomes of influenza A （H1N1）-infected patients. Methods A total of 60 cases with influenza A （H1N1） virus were enrolled. There were 32 mild cases, 16 healing cases from severe stage and 12 mortality cases resulting from severe stage. The serum levels of chemokines including CXCLS, CCL10, CCL2, CCL3, CCL4, CCL5 and CCL11 were detected by the Luminex technique. Results The levels of CXCL8, CCL2 and CCL10 in the mortality group were higher than those of the healing serve and mild cases. And the differences were significant. P value was 0. 001, 〈 0. 0001 and 0. 027 respectively. The thresholds of CCL2 and CXCL8 for predicting clinical mortality were 45.99 ng/L （ sensitivity 100%, specificity 89.58% ） and 59.75 ng/L （sensitivity 75%, specificity 95.83% ）. Conclusion The serum levels of chemokines are elevated in severe cases of influenza A （H1N1）. And the rises of CXCL8 and CCL2 are more obvious in the mortality cases. Thus CXCL8 and CCL2 may serve as two prognostic indices for the clinical fatal outcomes.