成人HPS临床特征及多种细胞因子水平与预后的相关性

Clinical Features of Adult HPS and the Correlation between Cytokine Levels and Prognosis

目的分析成人噬血细胞综合征(hemophagocytic syndrome,HPS)患者临床特征及多种细胞因子水平与预后相关性。方法收集19例成人噬血细胞综合征患者资料,分析其临床特征、实验室检查,并收集其血液样本进行12项细胞因子水平检测,分析其与预后的相关性。结果HPS患者细胞因子IL-1β、IL-2、IL-4、IL-8、IL-10、IL-6、IFN-γ、TNF-α的水平高于非HPS非感染患者组(P<0.05);HPS患者细胞因子IL-4、IL-5、IL-10、IFN-γ、TNF-α的水平高于非HPS感染患者组(P<0.05),IL-10、IFN-γ、TNF-α3种细胞因子ROC曲线示其AUC在0.7~0.9之间,用于诊断HPS具有一定的准确性。HPS死亡组患者发病时Fib明显低于存活组(P<0.05),而HPS死亡组患者发病时年龄、性别、临床特征(发热、肝脾、淋巴结肿大)及实验室检查(ALT、AST、TBIL、ALB、Fer、TG、ACN、HGB、PLT)与存活组,差异无统计学意义(P>0.05),而HPS死亡组患者发病时,IL-1β、IL-8、TNF-α明显高于存活组(P<0.05)。结论HPS可出现多种细胞因子水平升高,其中IL-10、IFN-γ、TNF-α明显升高可能对其诊断具有一定意义,Fib明显下降及IL-1β、IL-8、TNF-α明显升高可能提示预后不良。

Objective To analyze the clinical features of adult hemophagocytic syndrome(HPS)and the correlation between the levels of various cytokines and prognosis.Methods The data of 19 adult patients with hemophagocytic syndrome were collected,and the clinical features and laboratory tests were analyzed.The blood samples were collected for 12 cytokine levels detection,and the correlation between the levels and prognosis was analyzed.Results The levels of cytokines IL-1β,IL-2,IL-4,IL-8,IL-10,IL-6,IFN-γand TNF-αin HPS patients were higher than those in non-HPS non-infected patients(P<0.05).The levels of IL-4,IL-5,IL-10,IFN-γand TNF-αin HPS patients were higher than those in non-HPS patients(P<0.05),the ROC curve of IL-10,IFN-γand TNF-αshowed that the AUC of IL-10,IFN-γand TNF-αwas between 0.7 and 0.9,indicating accuracy in the diagnosis of HPS.Fib was significantly lower than that in the survival group(P<0.05),while there were no significant differences in age,sex,clinical features(fever,liver,spleen,lymphadenopathy)and laboratory tests(ALT,AST,TBIL,ALB,Fer,TG,ACN,HGB,PLT)between the HPS death group and the survival group(P>0.05),and the levels of IL-1β,IL-8 and TNF-αin HPS death group were significantly higher than those in survival group(P<0.05).Conclusion HPS may present increased levels of various cytokines,among which IL-10,IFN-γand TNF-αmay be significant for the diagnosis of HPS.The significant decrease of Fib and the significant increase of IL-1β,IL-8 and TNF-αmay indicate a poor prognosis.