血浆白细胞介素-17水平在急性呼吸窘迫综合征患者中的临床意义

The clinical significance of plasma interleukin-17 in patients with acute respiratory distress syndrome

目的探讨血浆白细胞介素-17(IL-17)表达水平对急性呼吸窘迫综合征(ARDS)患者的临床意义。方法纳入自2016年10月至2017年4月入住我院重症加强治疗病房(ICU)临床诊断ARDS患者45例,同期22例来自体检中心健康志愿者为对照组。收集研究对象急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、氧合及降钙素原、脑钠肽等临床资料,酶联免疫吸附试验法测定患者及对照组血浆IL-17、IL-6和IL-10水平。主要结局定义为随访28天时ICU或者院内病死率。结果与健康对照组比较,ARDS早期患者IL-6、IL-17增高,死亡组血浆IL-17、IL-6水平及APACHEⅡ、SOFA评分较存活组高。相关性分析提示IL-17的表达与IL-6水平具有相关性。Logistic回归及Cox模型分析均提示年龄及SOFA评分可能为ARDS的预后因素。结论血浆IL-17、IL-6在ARDS早期显著升高,IL-17与IL-6表达具有线性相关,二者为ARDS早期重要的炎性标志物,可能为评估病情程度及判断预后的重要辅助指标。

Objective To investigate the clinical signification of plasma interleukin-17(IL-17)1 evel in patients with acute respiratory distress syndrome(ARDS).Methods Forty-five adult ARDS patients and 22 healthy controls were enrolled in this study.The plasma cytokine levels of IL-17,IL-6 and IL-10 were measured by enzyme linked immunosorbent assay.Meanwhile,the baseline data of demographic and clinical tests including oxygenation index,procalcitonin and brain natriuretic peprtide were collected,the acute physiological and chronic healthⅡ(APACHEⅡ)score and sequential organ failure assessment(SOFA)score were recorded.The main outcome was defined as hospital mortality within 28-day follow-up.Results The plasma concentration of IL-17,IL-6 were higher in the ARDS patients(P<0.05)compared with the controls and the mean levels of IL-17,IL-6 and the APACHEⅡscore and the SOFA score in the non-survivors was higher than those in the survivors(P<0.05).In particular,there was a significant correlation between the plasma levels of IL-17 and IL-6(P<0.05).Logistic regression and COX multivariate survival analysis suggested that age and SOFA score may be prognostic factors for ARDS.Conclusions The plasma concentration of IL-17 is significantly increased in ARDS patients,and its expression is linearly related to the proinflammatory factor IL-6.Both are important inflammatory markers in the acute phase of ARDS and may be important disease severity and prognostic indicators in addition to age and SOFA score.