脓毒性休克患者早期主要炎性因子水平及其临床意义

Study on the levels of main inflammatory factors in septic shock and their clinical significance

目的探讨主要炎性因子与重症医学科(ICU)患者发生脓毒性休克的相关性,为其诊疗提供判断依据.方法选择2017年3月至2018年8月大同市第三人民医院ICU收治的成人患者为研究对象,根据脓毒性休克诊断标准将其分为脓毒性休克组和非脓毒症组.比较两组患者基本信息,包括年龄、性别、体重指数(BMI)、病程、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、感染部位和病原菌等,以及确诊后8 h内C-反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)、N末端B型脑钠肽前体(NT-proBNP)、肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)、白细胞介素(IL-1β、IL-2、IL-6、IL-8)等炎性因子水平.采用Logistic回归分析ICU患者发生脓毒性休克的危险因素.结果共入选154例ICU患者,其中有74例发生脓毒性休克.脓毒性休克组除APACHEⅡ评分显著高于非脓毒症组外(分:23.42±3.64比15.67±2.26,P<0.05),其他基线资料比较差异均无统计学意义.脓毒性休克组患者CRP、NT-proBNP、TNF-α、IFN-γ、PCT、IL-6、IL-8水平均明显高于非脓毒症组〔CRP(mg/L):164.3±22.6比52.3±16.2,NT-proBNP(ng/L):426.3±288.9比167.3±80.6,TNF-α(ng/L):193.4±39.3比88.1±20.3,IFN-γ(ng/L):133.3±52.0比97.0±56.1,PCT(ng/L):27.6±10.2比7.3±4.1,IL-6(ng/L):83.0±17.6比20.9±6.4,IL-8(ng/L):445.8±34.0比84.0±25.7,均P<0.05〕.Logistic回归分析显示,CRP、NT-proBNP、TNF-α、PCT、IL-6为ICU患者发生脓毒性休克的独立危险因素〔CRP:优势比(OR)=1.662,95%可信区间(95%CI)=1.132~2.567;NT-proBNP:OR=14.688,95%CI=3.580~20.238;TNF-α:OR=1.093,95%CI=1.043~1.343;PCT:OR=6.378,95%CI=4.556~12.243;IL-6:OR=9.641,95%CI=2.242~13.786,均P<0.05〕.结论CRP、NT-proBNP、TNF-α、PCT、IL-6等炎性因子水平明显升高是脓毒性休克早期诊断的重要因素.

Objective To explore the correlation between major inflammatory factors and septic shock in intensive care unit (ICU) patients, and to provide a basis for the diagnosis and treatment of septic shock. Methods The patients admitted to ICU of the Third People's Hospital of Datong from March 2017 to August 2018 were selected as the research objects. According to the diagnostic criteria of septic shock, the patients were divided into septic shock group and non-septic group. The basic information and inflammatory factors levels of the two groups, including age, gender, body mass index (BMI), course of disease, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), infection site and pathogenic;and C-reactive protein (CRP), procalcitonin (PCT), neutrophil lymphocyte ratio (NLR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-α(TNF-α),γ-interferon (IFN-γ), interleukins (IL-1β, IL-2, IL-6, IL-8) at 8 hours after diagnosis, were compared. Logistic regression was used to analyze the influencing factors of septic shock in ICU patients. Results A total of 154 ICU patients were selected, of whom 74 had septic shock. The APACHEⅡ score of septic shock group was significantly higher than that of non-sepsis group (23.42±3.64 vs. 15.67±2.26, P < 0.05). There was no significant difference in other baseline data between the two groups. The levels of CRP, NT-proBNP, TNF-α, IFN-γ, PCT, IL-6, IL-8 in the septic shock group were significantly higher than those in the non-septic group [CRP (mg/L): 164.3±22.6 vs. 52.3±16.2, NT-proBNP (ng/L): 426.3±288.9 vs. 167.3±80.6, TNF-α(ng/L): 193.4±39.3 vs. 88.1±20.3, IFN-γ(ng/L): 133.3±52.0 vs. 97.0±56.1, PCT (ng/L):27.6±10.2 vs. 7.3±4.1, IL-6 (ng/L): 83.0±17.6 vs. 20.9±6.4, IL-8 (ng/L): 445.8±34.0 vs. 84.0±25.7, all P < 0.05]. It was shown by Logistic regression analysis that CRP, NT-proBNP, TNF-α, PCT, IL-6 were independent risk factors for septic shock [CRP: odds ratio (OR)= 1.662, 95% confidence interval (95%CI)= 1.132-2.567;NT-proBNP: OR = 14.688, 95%CI = 3.580-20.238;TNF-α: OR = 1.093, 95%CI = 1.043-1.343;PCT: OR = 6.378, 95%CI = 4.556-12.243;IL-6: OR = 9.641, 95%CI = 2.242-13.786;all P < 0.05]. Conclusion The levels of inflammatory factors CRP, NT-proBNP, TNF-α, PCT and IL-6 were significantly increased, which were important factors for early diagnosis of septic shock.