老年脓毒症患者细胞因子谱及病情程度的差异性研究

Differences in cytokine profiles and disease severity in elderly patients with sepsis

目的探讨革兰氏阴性菌(Gram-negative bacteria,G^(-))、革兰氏阳性菌(Gram-positive bacteria,G^(+))引起的老年脓毒血症患者其细胞因子谱、血小板(platelet,PLT)水平和病情程度间的差异性。方法将104例老年脓毒症患者根据细菌培养结果分为G^(-)组79例和G^(+)组25例。检测2组患者血浆中细胞因子含量、血常规和凝血功能;绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估白细胞介素-6(interleukin-6,IL-6)、IL-10和PLT对确诊为G^(-)感染的诊断价值;分析2组患者病情严重程度间的关系。结果G^(-)组和G^(+)组的IL-6中位数分别为430.40和76.26 pg·mL^(-1),IL-10中位数分别为50.02和7.04 pg·mL^(-1),PLT分别为(135.00±77.03)×10^(9)和(196.64±86.55)×10^(9)/L,差异均有统计学意义(均P<0.05)。IL-6、IL-10和PLT单独诊断为G^(-)感染的曲线下面积分别为0.73,0.73和0.71,敏感度分别为77.20%,72.20%和64.00%,特异度分别为60.00%,72.00%和82.30%。G^(-)组和G^(+)组的脓毒症休克发生率分别为44.30%(35例/79例)和16.00%(4例/25例),差异有统计学意义(P<0.05)。在79株G^(-)菌中,大肠埃希菌35株(占44.30%)、肺炎克雷伯菌18株(占22.78%)。结论老年脓毒症患者以感染大肠埃希菌和肺炎克雷伯菌的G^(-)菌最为常见,其外周血IL-6、IL-10和PLT可作为G^(-)和G^(+)感染的早期鉴别依据,且G^(-)感染的脓毒症患者休克发生率更高。

Objective To investigate the differences of cytokine profiles,platelet(PLT)levels and disease severity in elderly patients with sepsis caused by Gram-negative bacteria(G^(-))and Gram-positive bacteria(G^(+)).Methods According to the bacterial culture results,104 elderly patients with sepsis were divided into G^(-)group with 79 cases and G^(+)group with 25 cases.Plasma cytokine levels,blood routine and coagulation function were detected in the two groups.Receiver operating characteristic(ROC)curves were drawn to evaluate interleukin-6(IL-6),IL-10 and PLT for the diagnosis of G^(-)infection.The relationship of disease severity were analyzed between two groups.Results The IL-6 levels(median)of G^(-)and G^(+)groups were 430.40 and 76.26 pg·mL^(-1);the IL-10 levels(median)were 50.02 and 7.04 pg·mL^(-1);the PLT were(135.00±77.03)×10^(9)and(196.64±86.55)×10^(9)/L;the differences were statistically significant(all P<0.05).The areas under the curve of IL-6,IL-10 and PLT alone for the diagnosis of G^(-)infection were 0.73,0.73 and 0.71;the sensitivities were 77.20%,72.20%and64.00%,and the specificities were 60.00%,72.00%and 82.30%,respectively.The incidences of septic shock in the G^(-)and G^(+)groups were 44.30%(35 cases/79 cases)and 16.00%(4 cases/25 cases)with significant difference(P<0.05).Among the 79 strains of G^(-)bacteria,there were 35 strains of Escherichia coli(44.30%)and 18 strains of Klebsiella pneumoniae(22.78%).Conclusion In elderly patients with sepsis,G^(-)bacteria infected with Escherichia coli and Klebsiella pneumoniae are the most common ones,and their peripheral blood IL-6,IL-10 and PLT can be used as early identification basis for G^(-)and G^(+)infections,and G^(-)infected sepsis patients have a higher incidence of shock.