血清白细胞介素-35、T细胞亚群与脓毒症病情严重程度及预后的关系

Relationship between serum interleukin-35, T cell subset and the severity and prognosis of patients with sepsis

目的探讨白细胞介素-35(IL-35)、T细胞亚群与脓毒症病情严重程度及预后的关系。方法选取安徽省淮南市第一人民医院(以下简称“我院”)2019年7月至2020年7月收治的240例脓毒症患者为病例组,根据其严重程度分为脓毒症组(71例)、严重脓毒症组(126例)、脓毒性休克组(43例);根据其入院28 d后的预后情况分为存活组(182例)和死亡组(58例)。另选取我院同期健康体检者60名为对照组。采用酶联免疫吸附试验检测各组血清IL-35,流式细胞仪检测其T细胞亚群。比较不同严重程度脓毒症患者急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)得分。比较存活组与死亡组脓毒症相关性器官功能衰竭评价(SOFA)得分。分析病例组血清IL-35、T细胞亚群与APACHEⅡ、SOFA得分的相关性。采用受试者操作特征曲线评估IL-35、CD4^(+)/CD8^(+)对脓毒症预后的预测价值。结果病例组IL-35、CD8^(+)水平高于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于对照组,差异有统计学意义(P<0.05)。严重脓毒症组、脓毒性休克组IL-35、CD8^(+)水平及APACHEⅡ得分均高于脓毒症组,且脓毒症休克组高于严重脓毒症组,差异均有统计学意义(P<0.05)。严重脓毒症组、脓毒性休克组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于脓毒症组,且脓毒性休克组低于严重脓毒症组,差异均有统计学意义(P<0.05)。存活组IL-35、CD8^(+)水平及SOFA得分均低于死亡组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于死亡组,差异均有统计学意义(P<0.05)。病例组IL-35、CD8^(+)与APACHEⅡ、SOFA得分均呈正相关(r>0,P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)与APACHEⅡ、SOFA得分均呈负相关(r<0,P<0.05)。IL-35联合CD4^(+)/CD8^(+)预测脓毒症患者治疗28 d死亡的曲线下面积为0.923,灵敏度、特异性分别为91.38%、95.05%。结论血清IL-35、T细胞亚群异常改变与脓毒症患者病情严重程度及预后密切相关,早期联合检测可作为临床辅助预测预后的重要指标。

Objective To explore the relationship between serum interleukin-35(IL-35),T cell subset and the severity and prognosis of patients with sepsis.Methods A total of 240 patients with sepsis admitted to Huainan First People’s Hospital,Anhui Province(hereinafter referred to as“our hospital”)from July 2019 to July 2020 were selected as the case group.According to their severity,they were divided into sepsis group(71 cases),severe sepsis group(126 cases)and septic shock group(43 cases).According to their prognosis 28 days after admission,they were divided into survival group(182 cases)and death group(58 cases).Sixty healthy subjects from our hospital during the same period were selected as control group.Serum IL-35 was detected by enzyme linked immunosorbent assay and T cell subsets were detected by flow cytometry.Acute physiology and chronic health evaluation(APACHEⅡ)scores of sepsis patients with different severity were compared.Sepsis-related organ failure assessment(SOFA)scores were compared between the survival group and the death group.The correlation of serum IL-35 and T cell subsets with APACHEⅡand SOFA scores in the case group was analyzed.The predictive value of IL-35 and CD4^(+)/CD8^(+)on the prognosis of sepsis was evaluated by the receiver operating characteristic curve.Results The levels of IL-35 and CD8^(+)in the case group were higher than those in the control group,and the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the case group were lower than those in the control group,with statistical significance(P<0.05).The levels of IL-35,CD8^(+),and APACHEⅡscores in the severe sepsis group and septic shock group were higher than those in the sepsis group,and those in the septic shock group was higher than the severe sepsis group,the differences were statistically significant(P<0.05).The levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in severe sepsis group and septic shock group were lower than those in severe sepsis group,and the levels of septic shock group were lower than those in severe sepsis group,with statistical significance(P<0.05).The levels of IL-35,CD8^(+),and SOFA scores in the survival group were lower than those in the death group,and the levels of CD3^(+),CD4^(+)and,CD4^(+)/CD8^(+)were higher than those in the death group,with statistical significance(P<0.05).IL-35 and CD8^(+)in the case group were positively correlated with APACHEⅡand SOFA scores(r>0,P<0.05),while CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)were negatively correlated with APACHEⅡand SOFA scores(r<0,P<0.05).The area under the curve of IL-35 combined with CD4^(+)/CD8^(+)in predicting the death of sepsis patients after 28 days of treatment was 0.923,and the sensitivity and specificity were 91.38%and 95.05%,respectively.Conclusion Abnormal changes of serum IL-35 and T cell subsets are closely related to the severity and prognosis of patients with sepsis.Early combined detection can be used as an important indicator for clinical auxiliary prediction of prognosis.