血清白细胞介素-2及可溶性白细胞介素-2受体水平对儿童感染相关性噬血细胞综合征的诊断及与预后相关性的研究

Diagnostic value of serum IL-2 and sIL-2R levelsfor infection associated hemophagocytic The relationship between serum IL-2 and sIL-2R levels and diagnostic and prognostic values in children with infection associated hemophagocytic syndrome

目的探讨白细胞介素-2(IL-2)及血清中可溶性白细胞介素-2受体(sIL-2R)水平对儿童感染相关性噬血细胞综合征(infection associated hemophagocytic syndrome,IAHS)的诊断及预后评估价值。方法选取2017年9月至2019年1月四川大学华西第二医院重症医学科收治的31例IAHS患儿以及35例脓毒症患儿作为研究对象,采用双抗体夹心酶联免疫吸附法检测两组患儿血清IL-2、sIL-2R表达水平。并选取同期在我院门诊进行健康体检的26例健康体检儿童作为健康对照组。采用受试者工作特征曲线(ROC)分析IL-2、sIL-2R的临床诊断价值。结果IAHS组患儿PICU住院时间及28 d病死率明显高于脓毒症组(P<0.05);IAHS组血清IL-2、sIL-2R水平>脓毒症组>健康对照组,差异有统计学意义(P<0.05)。20例IAHS组患儿经治疗后病情缓解,其血清IL-2、sIL-2R水平明显低于疾病高峰期,血小板、NK细胞百分比在疾病缓解后明显升高(P<0.05);死亡组血清IL-2、sIL-2R水平及铁蛋白较存活组均明显增高,血小板均降低(P<0.05)。结论血清IL-2、sIL-2R水平可能是诊断儿童IAHS的特异性指标,对预测IAHS疗效及评估预后有参考价值。

Objective To investigate the diagnostic and prognostic value of interleukin-2(IL-2)and serum soluble interleukin-2 receptor(sIL-2R)levels for children with infection associated hemophagocytic syndrome(IAHS).Methods Thirty-one children with IAHS and 35 children with sepsis admitted to our department of intensive care from September 2017 to January 2019 were enrolled in this study.Double antibody sandwich enzyme-linked immunosorbent assay was used to detect the expression levels of serum IL-2 and sIL-2R in the two groups.Twenty-six children with healthy physical examination in our hospital during the same period were selected as healthy controls.The receiver operating characteristic curve(ROC)analysis was used to analyze the clinical diagnostic value of IL-2 and sIL-2R.Results The PICU hospitalization time and 28-day mortality rate of patients in the IAHS group were significantly higher than those in the sepsis group(P<0.05).Serum IL-2 and sIL-2R levels in the IAHS group were>the sepsis group>the healthy control group(P<0.05).Twenty children in the IAHS group were relieved after treatment and their serum IL-2 and sIL-2R levels were significantly lower than those at the peak of the disease,and the percentage of platelets and NK cells were increased significantly after the disease was relieved(P<0.05).The levels of serum IL-2 and sIL-2R and ferritin in the death group were significantly higher than those in the survival group,and the platelets were decreased(P<0.05).Conclusion Serum IL-2 and sIL-2R levels may be specific indicators in the diagnosis of IAHS of children,and have reference value in predicting the treatment efficacy of IAHS and assessing the prognosis.