细胞因子免疫分型对脓毒症患儿病情及预后的评价作用

Evaluation of cytokine immunotyping on the condition and prognosis of children with sepsis

目的:探讨血清细胞因子及免疫分型对脓毒症患儿病情严重程度及预后的评价作用。方法:纳入2018年5月至2019年5月入住湖南省儿童医院PICU 2科的脓毒症患儿160例,收集患儿入科24 h内生命体征、血常规、血生化指标,同期血样送检血清白细胞介素(interleukin,IL)-2、IL-4、IL-6、IL-10及肿瘤坏死因子(tumor necrosis factor,TNF)-α、干扰素(interferon,IFN)-γ。根据患儿入科第1个24小时内病情最差值,按照2015年儿童脓毒性休克诊治专家共识诊断标准分为脓毒症组(76例)、严重脓毒症组(84例);根据28 d预后情况分为存活组(134例)、死亡组(26例);比较各组间细胞因子浓度及各种免疫状态构成。结果:严重脓毒症组与脓毒症组相比,IL-2[2.40(2.40,2.55)pg/mL比2.40(2.40,3.76)pg/mL]、IL-6[60.54(23.22,250.38)pg/mL比21.47(8.83,57.94)pg/mL]、IL-10[50.85(21.74,217.12)pg/mL比14.99(9.23,28.79)pg/mL]、TNF-α[2.75(2.40,5.15)pg/mL比2.40(2.40,3.23)pg/mL]和IFN-γ[8.01(4.34,37.28)pg/mL比2.62(2.62,28.56)pg/mL]水平均显著增高(P<0.05);死亡组与存活组相比,IL-10[99.57(10.51,646.96)pg/mL比23.17(11.74,57.30)pg/mL]、TNF-α[3.08(2.40,5.13)pg/mL比2.45(2.40,3.80)pg/mL]水平均显著增高(P<0.05);混合型抗炎症反应综合征(mixed antagonistic response syndrome,MARS)相比非MARS的死亡风险显著增高(OR 3.750,95%CI 1.302-10.804)。结论:IL-2、IL-6、IL-10及TNF-α水平增高与儿童脓毒症病情严重程度显著相关;IL-10、TNF-α水平增高及MARS的发生与不良预后显著相关,当脓毒症患儿出现MARS时需高度警惕不良预后的发生。

Objective To evaluate the effect of serum cytokines and immune typing on the severity and prognosis of children with sepsis.Methods One hundred and sixty children with sepsis admitted to No.2 PICU from May 2018 to May 2019 at Hunan Children′s Hospital were enrolled.Vital signs,blood routine and blood biochemical indexes of the children were collected within 24 hours after admission.Serum cytokine concentrations of interleukin(IL)-2,IL-4,IL-6,IL-10,tumor necrosis factor(TNF)-α,and interferon(IFN)-γwere tested at the same time.According to the worst condition during the first 24 h after admission,and the consensus diagnostic criteria of experts in the diagnosis and treatment of septic shock in children in 2015,the patients were divided into sepsis group(76 cases)and severe sepsis group(84 cases).According to the prognosis of 28 days,the patients were divided into survival group(134 cases)and death group(26 cases).The differences of cytokine concentration and the composition of immune state among groups were compared.Results The levels of IL-2[2.40(2.40,2.55)pg/mL vs.2.40(2.40,3.76)pg/mL],IL-6[60.54(23.22,250.38)pg/mL vs.21.47(8.83,57.94)pg/mL],IL-10[50.85(21.74,217.12)pg/mL vs.14.99(9.23,28.79)pg/mL],TNF-α[2.75(2.40,5.15)pg/mL vs.2.40(2.40,3.23)pg/mL]and IFN-γ[8.01(4.34,37.28)pg/mL vs.2.62(2.62,28.56)pg/mL]in the severe sepsis group were significantly higher than those in the sepsis group(P<0.05).The levels of IL-10[99.57(10.51,646.96)pg/mL vs.23.17(11.74,57.30)pg/mL]and TNF-α[3.08(2.40,5.13)pg/mL vs.2.45(2.40,3.80)pg/mL]in the death group were significantly higher than those in the survival group(P<0.05).The risk of death in children with mixed antagonistic response syndrome(MARS)was significantly higher than those without MARS(OR 3.75,95%CI 1.302-10.804).Conclusion The increased concentrations of IL-2,IL-6,IL-10,TNF-α,and IFN-γare significantly correlated with the severity of sepsis in children.Increased IL-10 concentration and the occurrence of MARS are significantly correlated with poor prognosis.The occurrence of MARS in children with sepsis should be highly vigilant for the poor prognosis.