外周血Th17细胞对脓毒症急性肾损伤的早期诊断价值

The early diagnostic value of peripheral blood Th17 cells in sepsis with acute kidney injury

目的探讨外周血Th17细胞水平在脓毒症急性肾损伤(AKI)早期诊断中的临床意义。方法选取该院2012年8月至2016年8月收治的脓毒症患者300例作为研究对象,其中65例患者合并AKI;另选取80例健康体检者作为对照组。检测研究对象外周血Th17细胞、白细胞介素(IL)-17、IL-6及胱抑素C(Cys C)水平,记录急性生理与慢性健康状况(APACHEⅡ)评分情况;对外周血Th17细胞与IL-17、IL-6、Cys C水平及APACHEⅡ评分进行相关性分析,通过受试者工作特征曲线(ROC曲线)评价外周血Th17细胞水平在早期诊断脓毒症AKI中的诊断价值。结果脓毒症AKI组患者外周血Th17细胞、IL-17、IL-6及Cys C水平明显高于非AKI组和对照组,差异均有统计学意义(P<0.05)。给予相应治疗后,AKI组患者外周血Th17细胞、IL-17、IL-6及Cys C水平均较治疗前明显下降,差异有统计学意义(P<0.05);相关性分析显示,外周血Th17细胞水平与IL-17、IL-6、Cys C及APACHEⅡ评分均呈正相关(r=0.81、0.65、0.72、0.76,P<0.01)。ROC曲线分析显示,外周血Th17细胞对诊断脓毒症AKI的敏感度和特异度分别为86.1%和83.5%,ROC曲线下面积(AUC)为0.850(95%CI:0.771~0.912),明显高于IL-17、IL-6及Cys C。结论外周血Th17细胞水平在脓毒症AKI患者中明显升高,可作为脓毒症AKI的早期诊断标志物。

Objective To investigate the clinical significance of Th17 cells level in peripheral blood in early diagnosis of sepsis patients with acute kidney injury（AKI）.Methods A total of 300 cases of sepsis treated in the hospital from August 2012 to August 2016 were enrolled in the study,there were 65 patients with AKI and another 80 volunteers who underwent the healthy assessment as control group.Peripheral blood Th17 cells,interleukin（IL）-17,IL-6 and serum Cystatin C（Cys C）levels were measured,the acute physiology and chronic health status（APACHE Ⅱ）score were recorded;the correlation between Th17 cells and IL-17,IL-6,Cys C and APACHE Ⅱ score were analyzed,and the value of early diagnosis of Th17 cells in peripheral blood was assessed by the receiver operating characteristic curve（ROC）.Results The Th17 cells,IL-17,IL-6 and Cys C levels of sepsis with AKI group were higher than those in non-AKI group and control group,and the differences were statistically significant（P〈0.05）.After appropriate treatment,the Th17 cells,IL-17,IL-6 and Cys C levels in AKI group were significant lower than those before treatment,and the differences were statistically significant（P〈0.05）;the correlation analysis showed that the levels of Th17 cells in peripheral blood positively correlated with IL-17,IL-6,Cys C and APACHE Ⅱ scores（r=0.81,0.65,0.72,0.76,P〈0.01）.ROC curve analysis showed that the sensitivity and specificity of Th17 cells in peripheral blood in the diagnosis of sepsis with AKI were 86.1% and 83.5%,respectively,and the area under the ROC curve（AUC）was 0.850（95%CI：0.771-0.912）,which were significant higher than those of IL-17,IL-6 and Cys C.Conclusion The levels of Th17 cells in peripheral blood in sepsis patients with AKI significantly increases,which could be used as early diagnosis markers of sepsis with AKI.