血清IL-6、IL-17水平对AECOPD合并肺部感染的早期诊断价值及病原菌分析

The value of serum IL-6 and IL-17 levels in the early diagnosis of AECOPD complicated with pulmonary infection and analysis of pathogenic bacteria

目的分析血清白细胞介素-6(IL-6)、白细胞介素-17(IL-17)水平对慢性阻塞性肺疾病急性加重(AECOPD)合并肺部感染的早期诊断价值及病原菌情况。方法选取2018年12月至2020年12月首都医科大学附属北京潞河医院呼吸内科收治的203例AECOPD患者作为研究对象,根据患者是否合并肺部感染将121例患者作为感染组,82例患者作为非感染组,采用酶联免疫吸附法(ELISA)检测血清中IL-6、IL-17水平,采用受试者工作特征曲线(ROC)评估IL-6、IL-17诊断效能,检测患者痰液病原菌分布情况,分析AECOPD合并肺部感染的危险因素。结果感染组血清IL-6、IL-17水平高于非感染组,差异有统计学意义(P<0.05);IL-6对AECOPD合并肺部感染的诊断AUC为0.753,IL-17对AECOPD合并肺部感染的诊断曲线下面积(Area Under Curve,AUC)为0.781,联合诊断对AECOPD合并肺部感染的诊断AUC为0.894(95%CI:0.814~0.997),明显高于单项(P<0.05);AECOPD合并肺部感染患者病原菌中革兰氏阴性菌占63.30%,革兰氏阳性菌占31.19%,真菌占5.51%;年龄≥60岁、住院时间≥14天、机械通气时间≥48 h、血清IL-6≥35.28 ng/L、血清IL-17≥288.17 ng/L均是AECOPD合并肺部感染的危险因素(P<0.05)。结论血清IL-6、IL-17是AECOPD合并肺部感染的早期诊断指标及危险因素,AECOPD合并肺部感染病原菌主要为革兰氏阴性菌株。

Objective To analyze the value of serum interleukin-6(IL-6) and interleukin-17(IL-17)in the early diagnosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) with lung infection and the pathogenic bacteria.Methods A total of 203 AECOPD patients admitted to the Department of Respiratory Medicine,Beijing Luhe Hospital,Capital Medical University from December 2018 to December2020 were selected as the research objects.According to whether the patient has pulmonary infection or not,121 patients were regarded as the infected group and 82 patients were regarded as the non-infected group.The levels of IL-6 and IL-17 in serum were detected by enzyme-linked immunosorbent assay(ELISA),the diagnostic efficacy of IL-6 and IL-17 was evaluated by receiver operating characteristic curve(ROC),and the distribution of pathogenic bacteria in sputum of patients was detected.The risk factors for AECOPD complicated with pulmonary infection were analyzed.Results The levels of serum IL-6 and IL-17 in the infected group were higher than those in the non-infected group,and the difference was statistically significant(P<0.05).The AUC of IL-6 for the diagnosis of AECOPD with pulmonary infection was 0.753,the area under the curve(AUC) of IL-17 for the diagnosis of AECOPD with pulmonary infection was 0.781,and the AUC of the combined diagnosis for the diagnosis of A with pulmonary infection was 0.894(95% CI:0.814~0.997),which was significantly higher than the single detection(P<0.05);Gram-negative bacteria accounted for 63.30%,Grampositive bacteria accounted for 31.19%,and fungi accounted for 5.51%.Age≥60 years old,hospital stay≥14 days,mechanical ventilation time≥48 h,serum IL-6≥35.28 ng/L,serum IL-17≥288.17 ng/L were all risk factors for AECOPD complicated with pulmonary infection(P<0.05).Conclusion Serum IL-6 and IL-17 are early diagnostic indicators and risk factors for AECOPD complicated with lung infection.The pathogens in AECOPD complicated with lung infection are mainly Gram-negative strains.