血清IL-6联合淋巴细胞/单核细胞比值对严重烧伤患儿脓毒血症诊断及预后评估的价值

Prognostic and diagnostic value of serum IL-6 combined with lymphocyte/monocyte ratio for sepsis of children with severe burn

目的探讨血清白细胞介素-6(IL-6)联合淋巴细胞/单核细胞比值(LMR)对严重烧伤患儿脓毒血症诊断及预后评估的临床意义。方法回顾性分析郑州大学附属儿童医院和郑州市第一人民医院2015年12月—2020年6月收治的78例重度及以上烧伤患儿的临床资料,收集患儿入院时、伤后7 d、伤后14 d、伤后21 d的血常规及血清IL-6结果。根据患儿是否出现脓毒血症,分为脓毒血症组与非脓毒血症组;根据患儿预后结局,分为生存组和死亡组。同时综合考虑患儿性别、年龄、烧伤总面积(TBSA)、是否伴有吸入性损伤、是否行机械通气等指标,比较不同组之间的差异;受试者工作特征(ROC)曲线预测伤后7 d及伤后14 d IL-6联合LMR对脓毒血症的诊断价值;Kaplan-Meier法预测IL-6及LMR对严重烧伤患儿生存率的影响。结果脓毒血症组与非脓毒血症组患儿是否伴有吸入性损伤、是否行机械通气、TBSA、淋巴细胞绝对数及伤后7 d、伤后14 d、伤后21 d IL-6水平和LMR比较,差异有统计学意义(P<0.05);生存组与死亡组是否行机械通气、有无脓毒血症、TBSA、IL-6水平和LMR比较,差异有统计学意义(P<0.05);IL-6与TBSA呈正相关(P<0.05),LMR与TBSA呈负相关(P<0.05);伤后7 d ROC曲线分析结果显示,IL-6联合LMR诊断脓毒血症的曲线下面积(AUC)为0.767,敏感性为93.9%,特异性为59.3%,比单独IL-6诊断更有效(P<0.05);伤后14 d IL-6联合LMR的AUC为0.713,敏感性为93.9%,特异性为69.0%,比单独IL-6诊断更有效(P<0.05);Kaplan-Meier生存曲线显示,伤后7 d低LMR组和高LMR组患儿住院期间总生存率分别为54.0%和94.8%,伤后14 d低LMR组和高LMR组患儿住院期间总生存率分别为25.0%和98.4%。伤后7 d低IL-6组和高IL-6组严重烧伤患儿住院期间的总生存率分别为98.0%和55.6%,伤后14 d低IL-6组和高IL-6组总生存率分别为100.0%和45.8%。结论对严重烧伤患儿,伤后7 d、伤后14 d IL-6联合LMR对脓毒血症诊断及患儿预后评估具有更好的临床指导意义。

Objective To explore the value of serum IL-6 combined with lymphocyte/monocyte ratio(LMR)in the occurrence and prognosis of sepsis in children with severe burn.Methods The clinical data of 78 children with severe burn treated in the affiliated Children's Hospital of Zhengzhou University and the first people's Hospital of Zhengzhou from December 2015 to June 2020 were analyzed retrospectively.The results of blood routine and serum IL-6 were collected on admission,day 7,day 14,and day 21 after burn.The patients were divided into sepsis group and non-sepsis group according to whether they had sepsis or not,survival group,and death group according to the prognosis,with the sex,age,(TBSA)of total burn area,inhalation injury,mechanical ventilation and other indexes taken into account.The predictive value of IL-6 combined with LMR on sepsis on day 7 and day 14 was analyzed by receiver operating characteristic curve(ROC)curve,and the effects of IL-6 and LMR on the survival rate of severe burn patients were analyzed by Kaplan-Meier method.Results There were significant differences in inhalation injury,mechanical ventilation,TBSA,absolute number of lymphocytes,and the levels of IL-6 and LMR on day 7,day 14,and day 21 after burn between the sepsis group and the non-sepsis group(P<0.05);there were significant differences in mechanical ventilation,sepsis,TBSA,LMR,and IL-6 between the survival group and the death group(P<0.05);there was a positive correlation between IL-6 and TBSA(P<0.05),and a negative correlation between LMR and TBSA(P<0.05).On day 7 after burn,the area under the curve(AUC)of ROC curve analysis of IL-6 combined with LMR was 0.767,the sensitivity was 93.9%,and the specificity was 59.3%.And on the day 14,the AUC of IL-6 combined with LMR was 0.713,the sensitivity was 93.9%,and the specificity was 69.0%,which was more effective than that of IL-6 alone(P<0.05).The Kaplan-Meier survival curve showed that the overall survival rates of severe burns in the high IL-6 group and the low IL-6 group on the day 7 after burn were 55.6%and 98.0%;the overall survival rates of the high IL-6 group and the low IL-6 group on the day 14 after burn were 45.8%and 100.0%;the overall survival rates of patients in low LMR group and high LMR group on the day 7 were 54.0%and 94.8%;the overall survival rates of patients in low LMR group and high LMR group on day 14 were 25.0%and 98.4%.Conclusion IL-6 combined with LMR on day 7 and day 14 after injury has better predictive value and clinical significance for the occurrence and prognosis of sepsis for children with severe burn.