IL-6对脓毒症的早期预警作用及抗感染疗效的预测价值

Clinical study of IL-6 on early warning sepsis and predicting anti-infective efficacy

目的:探讨白细胞介素-6(IL-6)对脓毒症的早期预警作用及对抗感染疗效的预测价值。方法:选取195例感染患者为研究对象,根据感染类型分为脓毒症组(n=88)、社区获得性肺炎组(n=76)和急性上呼吸道感染组(n=31);脓毒症组再根据病情转归分为好转组(n=70)和死亡组(n=18)。比较不同感染类型患者治疗前及不同转归患者抗感染治疗前、治疗后第3天、第7天血清IL-6及PCT水平,分析IL-6对脓毒症的早期预警作用和抗感染治疗疗效的预测价值。结果:脓毒症组患者IL-6及PCT水平均高于社区获得性肺炎组和急性上呼吸道感染组(P<0.05);社区获得性肺炎组IL-6水平高于急性上呼吸道感染组(P<0.05)。抗感染治疗前,脓毒症不同转归患者血清IL-6及PCT水平无统计学差异(P>0.05);抗感染治疗后脓毒症好转组第3天及第7天血清IL-6水平、第7天血清PCT水平均显著低于死亡组(P<0.05)。ROC曲线分析显示,血清IL-6对脓毒症患者诊断的曲线下面积(AUC)为0.926(95%CI:0.902~0.945,P<0.05),敏感度为84.3%,特异度为86.3%。结论:血清IL-6水平对脓毒症有很好的早期预警作用,在脓毒症的抗感染治疗过程中,监测IL-6水平可以预测抗感染的疗效及判断患者的预后。

Objective:To explore the early warning role and the prediction of anti-infective efficacy of IL-6 on sepsis.Methods:A total of 195 infected patients were selected and divided into sepsis group(n=88),community-acquired pneumonia group(n=76),acute upper respiratory tract infection group(n=31).The sepsis group was divided into improvement group(n=70) and death group(n=18) according to the outcome of the disease.The serum IL-6 and PCT levels of patients with different outcomes were compared before treatment, before anti-infective treatment, on the 3 rd day and on the 7 th day after treatment, and the predictive value of IL-6 in the treatment of sepsis was analyzed.Results:The levels of IL-6 and PCT in the sepsis group were higher than those in the community-acquired pneumonia group and acute upper respiratory tract infection group(P<0.05).The level of IL-6 in community-acquired pneumonia group was higher than that in acute upper respiratory tract infection group(P<0.05).Before anti infection treatment, there was no significant difference in serum IL-6 and PCT levels among patients with sepsis with different outcomes(P>0.05).The levels of serum IL-6 on the 3 rd and 7 th days, and PCT on the 7 th day of sepsis improvement group were signidicantly lower than those of death group(P<0.05).The ROC curve showed that IL-6 had a good diagnostic value in patients with sepsis, the AUC was 0.926(95% CI:0.902-0.945,P<0.001),sensitivity was 84.3%,specificity was 86.3%.Conclusion:Serum IL-6 level has a good early warning effect on sepsis.In the process of anti-infective treatment of sepsis, monitoring the level of IL-6 can predict the efficacy of anti-infection and judge the prognosis of patients.