成人噬血细胞综合征患者血浆IL-6,IL-8和IL-10水平分析及其与预后的相关性研究

Analysis of IL-6,IL-8 and IL-10 Levels in Adult Patients with Hemophagocytic Syndrome and Their Correlation with Prognosis

目的检测成人噬血细胞综合征(hemophagocytic syndrome,HPS)患者血浆IL-6,IL-8和IL-10水平,并分析其与预后相关性。方法选取2018年1月~2021年1月昆明医科大学第一附属医院收治的成人噬血细胞综合征患者60例为研究对象(HPS组),根据患者处于急性期或缓解期分为急性期组(n=32)和缓解期组(n=28),根据患者结局分为存活组(n=51)和死亡组(n=9)。选择同期60例健康体检人群作为对照组。采用流式细胞术分析血液中免疫活性细胞含量、血浆IL-8,IL-10和IL-6水平。对患者进行随访,采用Kaplan-Meier法分析细胞因子IL-8,IL-10,IL-6表达水平与患者生存时间的关系。结果HPS组NK细胞检出率(15.59%±2.81%)显著低于对照组(23.92%±3.92%),CTL细胞(31.07%±3.29%)、单核细胞(7.59%±1.84%)检出率显著高于对照组(22.53%±5.41%,5.16%±1.72%),差异均有统计学意义(t=12.969,11.224,8.728,均P<0.05)。HPS组血浆IL-6(83.2±9.8pg/ml),IL-8(104.8±14.3pg/ml)和IL-10(211.2±17.3pg/ml)水平显著高于对照组(31.1±7.4pg/ml,16.5±4.3pg/ml,26.9±1.9pg/ml),差异有统计学意义(t=39.824,62.382,115.630,均P<0.05)。急性期患者IL-6(99.8±7.5pg/ml),IL-8(127.6±12.9pg/ml)和IL-10(294.9±24.1pg/ml)水平显著高于缓解期(69.1±4.1pg/ml,84.8±6.6pg/ml,137.9±7.7pg/ml),差异有统计学意义(t=20.004,16.477,34.908,均P<0.05)。死亡组患者IL-6(125.1±16.7pg/ml),IL-8(193.9±25.8pg/ml)和IL-10(474.7±65.3pg/ml)水平显著高于存活组(75.8±6.3pg/ml,89.2±9.0pg/ml,164.7±18.7pg/ml),差异具有统计学意义(t=15.994,22.777,28.747,均P<0.05)。IL-6,IL-8,IL-10高水平患者中位生存时间(16.4±2.8月,14.7±3.8月,30.5±5.1月)明显低于低水平患者(24.7±5.3月,24.0±1.7月,55.3±4.7月),差异具有统计学意义(t=7.229,23.608,35.411,均P<0.05)。随着治疗的进行,HPS患者血浆IL-6,IL-8,IL-10水平呈下降趋势(t=5.025,17.395,8.337,均P<0.05)。结论细胞因子IL-6,IL-8和IL-10在HBS患者血浆中水平升高,高水平血浆IL-6,IL-8,IL-10与HBS患者预后不佳。

Objective To detect IL-6,IL-8,and IL-10 levels in adult patients with hemophagocytic syndrome(HPS)and analysis of their correlation with prognosis.Methods Sixty patients with hemophagocytic syndrome admitted to the First Affiliated Hospital of Kunming Medical University from January 2018 to January 2021 were selected as the research subjects(HPS group).They were divided into acute phase group(n=32)and remission phase group(n=28)based on their acute or remission phase,survival group(n=51)and death group(n=9)based on their outcomes,and 60 healthy individuals in the same period were selected as the control group.Flow cytometry was used to analyze the content of immune active cells in the blood and plasma levels of IL-8,IL-10,and IL-6.Follow up patients and analyze the relationship between the expression levels of cytokines IL-8,IL-10 and IL-6,and patient survival time using Kaplan Meier method.Results The detection rate of NK cells(15.59%±2.81%)in the HPS group was significantly lower than that in the control group(23.92%±3.92%),while the detection rates of CTL cells(31.07%±3.29%)and monocytes(7.59%±1.84%)were significantly higher than those in the control group(22.53%±5.41%,5.16%±1.72%)with statistically significant differences(t=12.969,11.224,8.728,all P<0.05).The levels of IL-6(83.2±9.8pg/ml),IL-8(104.8±14.3pg/ml)and IL-10(211.2±17.3pg/ml)in HPS group were significantly higher than those in control group(31.1±7.4pg/ml,16.5±4.3pg/ml,26.9±1.9pg/ml),the differences were statistically significant(t=39.824,62.382,115.630,all P<0.05).The levels of IL-6(99.8±9.8pg/ml),IL-8(127.6±12.9pg/ml)and IL-10(294.9±24.1pg/ml)in acute phase patients were significantly higher than those in remission phase patients(69.1±4.1pg/ml,84.8±6.6pg/ml,137.9±7.7pg/ml),with statistically significant differences(t=20.004,16.477,34.908,all P<0.05)..The levels of plasma IL-6(125.1±16.7pg/ml),IL-8(193.9±25.8pg/ml)and IL-10(474.7±65.3pg/ml)in the death group were significantly higher than those in the survival group(75.8±6.3pg/ml,89.2±9.0pg/ml,164.7±18.7pg/ml),with statistically significant differences(t=15.994,22.777,28.747,all P<0.05).The median survival time of patients with high levels of plasma IL-6,IL-8 and IL-10(16.4±2.8 months,14.7±3.8 months,30.5±5.1 months)was significantly lower than that of patients with low levels(24.7±5.3 months,24.0±1.7 months,55.3±4.7 months),and the differences were statistically significant(t=7.229,23.608,35.411,all P<0.05).As treatment progressed,the levels of plasma IL-6,IL-8 and IL-10 in HPS patients showed a decreasing trend(t=5.025,17.395,8.337,all P<0.05).Conclusion The levels of cytokines plasma IL-6,IL-8 and IL-10 were elevated in HBS patients,while high levels of IL-6,IL-8 and IL-10 have poor prognosis in HBS patients.