胡蜂蜇伤致全身炎症反应综合征的特征及相关危险因素分析

Analysis of characteristics and related risk factors of systemic inflammatory response syndrome caused by wasp stings

目的探讨胡蜂蜇伤致全身炎症反应综合征(SIRS)的相关危险因素。方法采用前瞻性病例对照研究分析2014年1月至2018年12月十堰市太和医院和安康市中心医院收治的225例胡蜂蜇伤患者临床资料.其中男131例,女94例;年龄49(41,60)岁。按照SIRS诊断标准分为SIRS组(62例)和非SIRS组(163例)。比较两组性别、年龄、头颈部蜇伤、四肢蜇伤、腰背部蜇伤、腹部蜇伤、蜇伤针数、就诊时间、住院时间及病死率:同时采集患者外周静脉血,采用ELISA法检测白细胞介素(IL)-6和IL-8水平。从白细胞中提取出全基因组DNA,并选取IL-6位点-174G/C、-572G/C、-597G/A、-634C/G和IL-8位点-251A/T、-738T/A、-845T/C、+396T/G,采用PCR进行扩增后双向测序并比对,记录基因分型和频数,采用单因素和多因素方法分析胡蜂蜇伤致SIRS的危险因素。结果(1)两组四肢蜇伤、腰背部蜇伤、腹部蜇伤、蜇伤针数、住院时间及病死率等方面差异均有统计学意义(P<0.01),而性别、年龄、头颈部蜇伤及就诊时间等差异均无统计学意义(P>0.05)。(2)ELISA检测结果显示,SIRS组IL-6和IL-8在血浆中的表达水平均高于非SIRS组(P<0.01)。(3)IL-6-572G/C位点存在CC、GC、GG三种基因型,SIRS组与非SIRS组间各基因型频数差异有统计学意义(P<0.01);IL-8-251 A/T位点存在AA、AT、TT三种基因型,SIRS组与非SIRS组间各基因型频数差异有统计学意义(P<0.01)。(4)单因素分析结果显示,腰背部蜇伤、腹部蜇伤、四肢蜇伤、蜇伤针数、IL-6-572G等位基因JL-8-251T等位基因胡蜂蜇伤致SIRS相关(P<0.01)。(5)多因素Logistics回归分析显示,四肢蜇伤(OR=2.15)伤针数≥10针(OR=11.10)、IL-6-572G等位基因(OR=3.91)、IL-8-251T等位基因(OR=3.97)均与胡蜂蜇伤致SIRS显著相关(P<0.05或0.01)。结论胡蜂蜇伤致SIRS患者血浆IL-6及IL-8的表达水平显著提升。IL-6-572G等位基因JL-8-251T等位基因、蜇伤针数≥10针和四肢蜇伤均是胡蜂蜇伤致SIRS的独立危险因素。

Objective To analyze the risk factors of systemic inflammatory response syndrome(SIRS)caused by wasp stings.Methods A prospective case-control study was conducted to analyze the clinical data of 225 patients with wasp stings admitted to Taihe hospital of Shiyan City and An kang Central Hospital from January 2014 to December 2018,including 131 males and 94 females,with the age of 49(41,60)years.The patients were divided into SIRS group(n=62)and non-SIRS group(ti=163)according to the SIRS diagnostic criteria.The data were collected including gender,age,sting in the head,sting in waist and back,sting in the abdomen,sting in the limbs,number of stings,admission time,hospitalization day,and mortality.The plasma levels of interleukin(IL)-6 and IL-8 in peripheral blood of the patients were analyzed by ELISA method.The whole genome DNA was extracted from white blood cells,and the IL-6:-174G/C,-572G/C,-597G/A,-634C/G and IL-8:-251A/T,-738T/A,-845T/C,+396T/G were selected for research.The PCR method was used to perform bidirectional sequencing and comparison after amplification,and record the genotyping and frequency.The risk factors of SIRS caused by wasp stings were investigated by univariate analysis and multivariate Logistics regression analysis.Results(1)The two groups showed significant differences in sting in the limbs,sting in waist and back,sting in the abdomen,number of stings,hospitalization day and mortality(P<0.01),while there were no significant differences in gender,age,sting in the head and admission time(P>0.05).(2)ELISA test showed the plasma levels of IL-6 and IL-8 in SIRS group were higher than those in non-SIRS group(P<0.01).(3)Three genotypes of CC,GC and GG were observed in IL-6-572G/C.There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group(P<0.01).Thiee genotypes of AA,AT and TT were observed in IL-8-251A/T.There were significant differences in the frequencies of genotypes and alleles between SIRS group and non-SIRS group(P<0.01).(4)Univariate analysis showed sting in waist and back,sting in the abdomen,sting in the limbs,number of stings,IL-6-572G allele,IL-8-251T allele were related to SIRS caused by wasp stings(PvO.Ol).(5)Multivariate Logistics regression analysis showed limb stings(OR=2.15),number of stings ≥10(OR=11.10),IL-6-572G allele(OR=3.91)and IL-8-25IT allele(OR=3.97)were significantly related to SIRS caused by wasp stings(P<0.05 or 0.01).Conclusions The plasma levels of IL-6 and IL-8 are increased in patients with SIRS after wasp stings.The limbs stings,number of stings ≥10,IL-6-572G and IL-8-25IT are all independent risk factors for SIRS caused by wasp stings.