脓毒症患者血清炎症细胞因子动态变化的研究

Dynamic changes of serum levels of cytokines in patients with sepsis

目的探讨脓毒症患者血清中主要促炎和抗炎细胞因子的浓度变化与疾病严重程度的关系。方法回顾性分析62例脓毒症患者,按病情分为脓毒症组(34例)和严重脓毒症组(28例),所有患者均在确诊脓毒症后第1,3,5,7天进行过细胞因子检测,同时选取同期进行过细胞因子检测的未诊断为脓毒症的住院患者30例作为对照组,用病历管理系统调取静脉血细胞因子IL-2R,IL-6、IL-8、IL-10浓度,用统计学方法分析各组细胞因子浓度变化趋势。结果严重脓毒症组患者血清中IL-2R,IL-6,IL-8浓度均较脓毒症组显著增高(均P<0.05),且均随时间推移和病情加重呈现逐渐增高的变化,严重脓毒症组抗炎因子IL-10较脓毒症组及对照组显著增高(均P<0.05),但脓毒症组抗炎因子IL-10较对照组未见明显升高。结论血清细胞因子IL-2R,IL-6,IL-8,IL-10浓度升高可作为评价脓毒症患者病情严重的指标,IL-10浓度明显升高提示患者存在严重脓毒症。

Objective To explore the relationship between the changes of main pro-inflammatory, anti-inflammatory cytokines and disease severity in the patients with sepsis. Methods Sixty-two patients with sepsis were divided into two groups：sepsis group （n = 34） and severe sepsis group（ n = 28 ）. The serum cytokines were detected at day 1,3, 5 and 7 after final diagnosis. Thirty patients without sepsis and inflammation at the same period were selected as control group. The concentrations of IL-2R, IL-6, IL-8, IL-10 in venous blood were obtained from medical records. The concentrations of cytokines and the changing tendency were compared between groups. Results The concentrations of IL-2R, IL-6, IL-8 in severe sepsis group were significantly increased in a time-dependent manner compared with sepsis group（ P 〈 0.01 ）. The concentration of anti-inflammatory cytokine IL-10 in severe sepsis group significantly increased compared with sepsis group and control group（P 〈0.05 ）. However, the concentration of anti-inflammatory eytokine IL-10 in the patients with sepsis was not significantly higher than that in controls. Conclusion The elevated levels of cytokine IL-2R, IL-6, IL-8, IL-10 in serum can be used important indexes for evaluating the severity of patients with sepsis. The significant increase of IL-10 may indicate the severe sepsis in the patients.