TNF-α、IL-10及CRP在脓毒症患者中的表达及其临床意义

Expression and clinical significance of TNF-α,IL-10 and CRP in patients with sepsis

目的分析肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)及C反应蛋白(CRP)在脓毒症患者中的表达及其临床意义。方法抽取2016年2月至2021年2月南阳市第一人民医院收治的脓毒症患者96例作为脓毒症组,并以1∶1配比抽取同期健康体检者96例作为健康对照组。比较两组的血清因子表达水平;比较脓毒症组中不同病情程度(一般脓毒症、严重脓毒症、脓毒症休克)、治疗后不同时间(治疗后3 h、1 d及3 d)、不同预后(生存、死亡)患者的血清因子表达水平;分析血清TNF-α、IL-10、CRP水平和病情程度、治疗后时间、预后的相关性。结果脓毒症组血清TNF-α、IL-10、CRP水平高于健康对照组(P<0.05)。脓毒症组中脓毒症休克患者血清TNF-α、IL-10、CRP水平高于一般脓毒症和严重脓毒症患者(P<0.05);脓毒症组患者治疗后3 d的血清TNF-α、IL-10、CRP水平低于其治疗后6 h及1 d(P<0.05);脓毒症组中存活者血清TNF-α、IL-10、CRP水平低于死亡者(P<0.05)。Pearson分析结果显示,TNF-α(r=0.647)、IL-10(r=0.591)、CRP(r=0.682)与病情程度呈正相关(P<0.05),TNF-α(r=-0.601)、IL-10(r=-0.574)、CRP(r=-0.629)与治疗后时间呈负相关(P<0.05),TNF-α(r=-0.582)、IL-10(r=-0.597)、CRP(r=-0.701)与预后呈负相关(P<0.05)。结论脓毒症患者机体炎性反应较强烈,存在促炎、抗炎失衡,血清TNF-α、IL-10、CRP表达水平较高,不仅随病情严重程度增加而升高,且随治疗后时间延长而降低,并和预后显著相关,临床可据此评估患者的病情严重程度及治疗效果,预测预后结局。

Objective To analyze the expression and clinical significance of tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)and C-reactive protein(CRP)in patients with sepsis.Methods Ninety-six patients with sepsis treated in Nanyang First People’s Hospital from February 2016 to February 2021 were selected as the sepsis group,and 96 healthy physical examination patients during the same period were selected as the healthy control group with a ratio of 1∶1.The expression levels of serum factors between the two groups were compared.The expression levels of serum factors in sepsis group were compared among patients with different degrees of illness(general sepsis,severe sepsis,septic shock),different time after treatment(3 hours,1 day and 3 days after treatment)and different prognoses(survival and death).The correlation of serum levels of TNF-α,IL-10,CRP with severity of disease,time after treatment,and prognosis was analyzed.Results The serum levels of TNF-α,IL-10,CRP of the sepsis group were higher than those of the healthy control group(P<0.05).The serum levels of TNF-α,IL-10,CRP of septic shock patients were higher than those of general sepsis and severe sepsis patients in the sepsis group(P<0.05).Serum levels of TNF-α,IL-10 and CRP in the sepsis group 3 days after treatment were lower than those of 6 hours and 1 day after treatment(P<0.05).The serum levels of TNF-α,IL-10 and CRP in the survivors were lower than those in the dead in the sepsis group(P<0.05).The results of Pearson analysis showed that TNF-α(r=0.647),IL-10(r=0.591),and CRP(r=0.682)were positively correlated to the severity of the disease(P<0.05);TNF-α(r=-0.601),IL-10(r=-0.574),and CRP(r=-0.629)were negatively correlated to treatment time(P<0.05);TNF-α(r=-0.582),IL-10(r=-0.597),and CRP(r=-0.701)were negatively correlated to prognosis(P<0.05).Conclusions Sepsis patients have strong inflammatory reaction,imbalance between pro-inflammatory and anti-inflammatory.The serum levels of TNF-α,IL-10,CRP of sepsis patients are high,which not only increased with the severity of the disease,but also decreased with the time after treatment,And the levels are significantly correlated with the prognosis.It can be used to evaluate the severity of disease and treatment effect,and predict the prognosis.