白细胞介素-35在脓毒症病情评估及预后中的应用

Application research of Interleukin-35 in sepsis correlated with condition evaluation and prognosis

目的通过观察脓毒症病人血清白细胞介素-35(IL-35)的变化规律,探讨其与感染的关系及对疾病预后的影响。方法采用前瞻性研究方法,选择67例脓毒症病人为脓毒症组;同时选择符合全身炎性反应综合征(SIRS)但无感染病人(30例)以及健康志愿者(30例)作为对照。于病人入重症医学科(ICU)3 h内取血,采用酶联免疫吸附试验(ELISA)检测IL-35、降钙素原(PCT),并计算急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,根据病人入院后28 d生存结局,比较存活组(57例)与死亡组(40例)病人之间IL-35水平的差异。采用多种非参数方法分析脓毒症病人IL-35与上述指标的相关性;获得IL-35诊断脓毒症及预后判断的价值。结果脓毒症病人血清IL-35较SIRS组及健康对照组明显升高[0.43(0.25)比0.24(0.09)、0.15(0.00)ng·L^(-1),Z=7.862,P<0.01],PCT较SIRS组明显升高[6.92(23.44)比2.09(1.53)μg·L^(-1),Z=-2.038,P<0.05],健康组、SIRS组,脓毒症组的APACHEⅡ评分、PCT、IL-35水平随疾病严重程度加深而升高,且脓毒症组IL-35与APACHEⅡ评分(r=0.587,P<0.001)、PCT(r=0.691,P<0.001)均呈显著正相关,此外,ROC分析知:以IL-35=0.30 ng·L^(-1)为阈值,其预测死亡预后的灵敏度=0.722,特异性=0.759,曲线下面积AUC=0.735,提示IL-35对脓毒症预后预测价值较好。结论脓毒症病人血清IL-35较SIRS组及健康对照组明显上升,且与PCT水平呈正相关,对感染有诊断意义;血清IL-35与APACHEⅡ评分呈正相关,故其水平随APACHEⅡ评分升高而升高,而且死亡组IL-35水平较存活组明显升高,IL-35水平的高低对脓毒症病人的预后有重要提示意义。

Objective To observe the changes ofinterleukin-35 （IL-35） in sepsis patients＇erumfor finding the relationship of the levels of IL-35 and the infection, and the significance of IL-35 in predicting the prognosis of sepsis. Methods A prospective clinical study was conducted. Sixty-seven patients with sepsis were enrolled. Thirty healthy volunteers and thirty patients with systemic inflammatory response syndrome （SIRS） were enrolled as healthy control and SIRS groups. The levels of IL-35, procalcitonin （ PCT） were deter-mined byenzyme linked immunosorbent assay （ELISA） within 3 h after admittedto ICU. The acute physiology and chronic health evalu-ation Ⅱ （ apache Ⅱ） score was calculated. Then,the patients were assigned into 28-daydeath group and survival group,and the lev-els of IL-35 were compared. The relationship between the levels of IL-35 and each parameter was analyzed byvarious non-parametric methods. The multi-factor Logistic regression analysiswas used in the diagnosis of sepsis severity and prognosis of independent factors. Results Serum IL-35 in sepsis patients was significantly increased compared with that of the control group[ng · L^-1 ： 0 .4 3 （0 . 2 5 ）： 0. 24（0. 09） ,0. 15（0. 00） ,Z = 7. 862 〈 0. 01 ]. PCT was significantly increased compared with that of the SIRS group [μg· L^-1 ：6. 92（23.44） ： 2. 09（ 1 .5 3 ） = - 2. 038 ,P 〈0. 05 ] . With exacerbation of illness, APACHE Ⅱ score, the values of PCT and the levelof IL-35 were gradually increased, Both IL-35 and APACHE Ⅱ or PCT hadsignificant positive correlation（ r = 0. 587 ,P 〈 0. 001 or r = 0. 691,P〈0. 001） . Besides, from ROC curve, the threshold of IL-35 was 0. 30 ng · L^-1 , the sensitivity of prognosis of death was 0. 722, the specificity was 0. 759, the area under the ROC curve was 0. 735 , which promptedthat IL-35 hadgood prognostic values to sep-sis. Conclusions The level of Serum IL-35 in sepsis patientswas increased compared withthe SIRS groupand healthy control group, and ithas positive correlation with PCT,which playsimportantrole in diagnosing infection. The level of serum IL-35 in sepsis patients has pos-itive correlation with APACHE Ⅱ. With the increasing of APACHE Ⅱ , the levels of IL-35 are increased andit in death group issignifi- cantly increased than alivegroup, and it has important significance to the prognosis of patients with sepsis.