脓毒症患者血清白细胞介素水平及临床意义

The level and clinical significance of serum interleukin in patients with sepsis

目的探讨脓毒症患者血清白细胞介素6(IL-6)、白细胞介素8(IL-8)、白细胞介素10(IL-10)、白细胞介素4(IL-4)水平,分析其临床诊断意义及预后预测价值。方法选取自2020年1月至2022年6月海军军医大学第一附属医院收治的150例脓毒症患者为脓毒症组,另选取同期收治的100例排除脓毒症的感染患者为非脓毒症组。根据28 d预后情况,将脓毒症患者分为存活组(n=96)与死亡组(n=54)。记录并比较脓毒症组与非脓毒症组患者入院时血清IL-6、IL-8、IL-10、IL-4、C反应蛋白(CRP)、降钙素原(PCT)水平。分析脓毒症患者血清IL-6、IL-8、IL-10、IL-4水平与PCT、急性生理与慢性健康评分(APACHEⅡ)的相关性。采用Logistic回归模型分析脓毒症患者28 d内死亡的危险因素,并采用受试者工作特征(ROC)曲线评价各指标对脓毒症患者28 d内死亡的预测价值。结果脓毒症组患者血清IL-6、IL-8、IL-10、IL-4、CRP、PCT水平均显著高于非脓毒症组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,脓毒症患者血清IL-6、IL-8、IL-10、IL-4水平与PCT水平(r=0.315、0.342、0.339、0.354)、APACHEⅡ评分(r=0.307、0.315、0.324、0.336)呈正相关(P<0.05)。死亡组患者血清IL-6、IL-8、IL-10、IL-4、PCT水平及APACHEⅡ评分显著高于存活组,差异有统计学意义(P<0.05)。多因素Logisitic回归分析结果显示,APACHEⅡ、IL-6、IL-10是脓毒症患者28 d内死亡的独立危险因素(P<0.05)。IL-6、IL-10、APACHEⅡ预测脓毒症患者28 d内死亡的ROC曲线下面积分别为0.796(95%可信区间0.723~0.858)、0.787(95%可信区间0.712~0.849)、0.819(95%可信区间0.747~0.877)。IL-6、IL-10、APACHEⅡ的ROC曲线下面积比较,差异无统计学意义(P>0.05)。结论脓毒症患者血清IL-4、IL-6、IL-8、IL-10表达水平升高,IL-6、IL-10及APACHEⅡ评分是脓毒症患者28 d内死亡的独立危险因素,且血清IL-6、IL-10水平对脓毒症患者28 d内死亡有较高预测价值。

Objective To investigate the levels of serum interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and interleukin-4(IL-4)in patients with sepsis,and to explore their clinical diagnostic significance and prognostic value.Methods A total of 150 patients with sepsis admitted to the First Affiliated Hospital of Naval Medical University from January 2020 to June 2022 were selected as the sepsis group,and 100 patients with infection excluding sepsis admitted to our hospital during the same period were selected as the non-sepsis group.According to the 28-day prognosis,the patients with sepsis were divided into survival group(n=96)and death group(n=54).The serum levels of IL-6,IL-8,IL-10,IL-4,C-reactive protein(CRP),and procalcitonin(PCT)of patients in sepsis group and non-sepsis group on admission were recorded and compared.The correlation between serum IL-6,IL-8,IL-10,IL-4 levels and PCT,acute physiology and chronic health evaluation(APACHEⅡ)score in patients with sepsis was analyzed.Logistic regression model was used to analyze the risk factors of 28-day death in patients with sepsis,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each index for 28-day death in patients with sepsis.Results The levels of serum IL-6,IL-8,IL-10,IL-4,CRP and PCT in sepsis group were significantly higher than those in non-sepsis group(P<0.05).Spearman correlation analysis showed that the levels of serum IL-6,IL-8,IL-10 and IL-4 in patients with sepsis were positively correlated with PCT level(r=0.315,0.342,0.339,0.354;P<0.05)and APACHEⅡscore(r=0.307,0.315,0.324,0.336;P<0.05).Compared with the survival group,the serum IL-6,IL-8,IL-10,IL-4,PCT and APACHEⅡscores of the death group were significantly higher(P<0.05).Logisitic regression analysis showed that APACHEⅡ,IL-6 and IL-10 were independent risk factors for 28-day death in patients with sepsis(P<0.05).The area under the ROC curve of IL-6,IL-10 and APACHEⅡin predicting the death of sepsis patients within 28 days was 0.796(95%credibility interval 0.723-0.858)、0.787(95%credibility interval 0.712-0.849)、0.819(95%credibility interval 0.747-0.877).There was no significant difference in the area under the ROC curve of IL-6,IL-10 and APACHEⅡ(P>0.05).Conclusion The expression levels of serum IL-4,IL-6,IL-8 and IL-10 in patients with sepsis are increased.IL-6,IL-10 and APACHEⅡscore are independent risk factors for the death of patients with sepsis within 28 days,and serum IL-6 and IL-10 levels have high predictive value for the death of patients with sepsis within 28 days.