脓毒症患者炎症因子与序贯器官衰竭评估评分水平的关系及对预后的预测价值

Relationship between inflammatory factors and sequential organ failure assessment in patients with sepsis and its prognostic value

目的探讨脓毒症患者炎症因子水平与序贯器官衰竭评估(SOFA)评分的关系,并分析炎症因子对患者预后的评估价值。方法回顾性分析2020年3月至2022年3月夏津县人民医院收治的155例脓毒症患者的临床资料,按照SOFA评分将其分为3组,轻症组(38例,1~5分)、中症组(42例,6~10分)及重症组(75例,>10分),根据患者的预后分为生存组(120例)和死亡组(35例)。比较疾病不同严重程度的3组患者及生存组、死亡组患者的血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平及SOFA评分,分析SOFA评分与炎症因子的相关性,并采用受试者工作特征(ROC)曲线分析炎症因子水平对患者预后的评估价值。结果轻、中、重症组患者血清IL-6、CRP、PCT、IL-10、TNF-α水平及SOFA评分呈逐渐升高趋势;经Pearson相关系数分析发现,不同严重程度脓毒症患者SOFA评分与血清IL-6、CRP、PCT、IL-10、TNF-α水平均呈正相关(r=0.424、0.385、0.414、0.445、0.438,均P<0.05);与生存组比,死亡组患者血清IL-6、CRP、PCT、IL-10、TNF-α水平及SOFA评分均升高(均P<0.05);ROC曲线显示,PCT评估脓毒症预后的曲线下面积(AUC)最大,约登指数最高(P<0.05)。结论脓毒症患者病情越严重,其机体炎症因子水平越高,SOFA评分与炎症因子具有明显的相关性;血清炎症因子可作为脓毒症预后评估的指标,其中PCT的应用价值相对较高。

Objective To investigate the relationship between inflammatory factor levels and sequential organ failure assessment(SOFA)score in patients with sepsis,and to analyze the prognostic value of inflammatory factor levels.Methods The clinical data of 155patients with sepsis admitted to Xiajin County People’s Hospital from March 2020 to March 2022 were retrospectively analyzed,according to SOFA score,they were divided into 3 groups,mild group(38 cases,1~5 points),moderate group(42 cases,6~10 points)and severe group(75cases,>10 points),according to the prognosis,patients were divided into survival group(120 cases)and death group(35 cases).The levels of serum interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and SOFA scores in the 3 groups of patients with different severity and in the survival group and death group were compared,the correlation of SOFA score with inflammatory factors was analyzed,receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of inflammatory factors.Results Serum levels of IL-6,CRP,PCT,IL-10,TNF-αand SOFA scores in mild,moderate and severe groups showed a gradual increase trend;SOFA score was positively correlated with serum levels of IL-6,CRP,PCT,IL-10 and TNF-αin patients with sepsis according to Pearson correlation coefficient analysis(r=0.424,0.385,0.414,0.445,0.438,all P<0.05);compared with survival group,serum levels of IL-6,CRP,PCT,IL-10,TNF-αand SOFA scores increased in death group(all P<0.05);the ROC curve showed that the area under curve(AUC)of the prognosis of sepsis evaluated by PCT was the largest,and the Yoden index was the highest(P<0.05).Conclusion The more severe the condition of sepsis patients,the higher the level of inflammatory factors in the body,SOFA score was significantly correlated with inflammatory factors,serum inflammatory factors can be used as prognostic indicators of sepsis,among which PCT has the highest application value.