IL-1β、IL-18、PMN在老年重症碳青霉烯类耐药肺炎克雷伯菌感染中的表达及其临床意义

The expression and clinical significance of IL-1β,IL-18 and PMN in elderly patients with severe carbapenem-resistant Klebsiella pneumoniae infectiopneumoniae infection in the elderly

目的 探讨老年重症碳青霉烯类耐药肺炎克雷伯菌(CRKP)感染抗菌疗程中白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)、中性粒细胞(PMN)变化及与疗效关联性。方法 选取2019年1月—2021年3月邯郸市第一医院收治的102例老年重症CRKP感染患者,均给予抗菌药物治疗,根据疗效分为无效组(n=25)、总有效组(n=77),比较两组基线资料、治疗前、治疗5 d后、治疗7 d后IL-1β、IL-18、PMN水平,应用皮尔森(Pearson)相关系数分析治疗5 d后、治疗7 d后IL-1β、IL-18、PMN与疗效关系,采用多因素Logistic回归方程分析疗效的相关影响因素。结果 总有效率组治疗5 d后、治疗7 d后IL-1β[(226.18±58.07)、(169.05±55.34)pg/mL]、IL-18[(57.07±12.29)、(42.66±13.27)ng/L]、PMN[(78.81±10.26)%、(65.48±12.30)%]均低于无效组[(275.34±51.96)、(273.82±49.72)pg/mL]、[(68.47±15.85)、(70.39±20.44)ng/L]、[(87.75±11.05)%、(88.37±10.99)%](F=12.365,P<0.001;F=20.072,P<0.001;F=18.974,P<0.001);治疗5 d后、治疗7 d后IL-1β(r=-0.729、-0.865,均P<0.001)、IL-18(r=-0.711、-0.804,均P<0.001)、PMN(r=-0.804、-0.967,均P<0.001)均与疗效相关;多因素Logistic回归分析显示,校正了混杂因素后,治疗7 d后IL-1β、IL-18、PMN仍是疗效的相关影响因素(P<0.05)。结论 老年重症CRKP感染抗菌疗程中IL-1β、IL-18、PMN变化情况与疗效有关,联合检测有望成为预测患者治疗反应性的生物标志物,从而为临床治疗提供参考。

Objective To investigate the interleukin-1β(IL-1β),interleukin-18(IL-18)and neutrophils(PMN)changes and their relevance to efficacy.Methods A total of 102 elderly patients with severe CRKP infection admitted to our hospital from January 2019 to March 2021 were treated with antibiotics.According to the efficacy,they were divided into ineffective group(n=25)and total effective group(n=77).The baseline data,levels of IL-1β,IL-18,and PMN before treatment,after treatment for 5 days,and after treatment for 7 days were compared between the two groups.Pearson was used to analyze IL-1β,IL-18,PMN after treatment for 5 days and after treatment for 7 days.In relation to the curative effect,the multivariate Logistic regression equation was used to analyze the relevant influencing factors of the curative effect.Results IL-1β[(226.18±58.07)pg/mL,(169.05±55.34)pg/mL],IL-18[(57.07±12.29)ng/L,(42.66±13.27)ng/L],PMN[(78.81±10.26)%,(65.48±12.30)%]after 5 days of treatment and 7 days of treatment in the total effective group]were lower than those of the null group[(275.34±51.96)pg/mL,(273.82±49.72)pg/mL],[(68.47±15.85)ng/L,(70.39±20.44)ng/L],[(87.75±11.05)%,(88.37±10.99)%](F=12.365,P<0.001;F=20.072,P<0.001;F=18.974,P<0.001);IL-1β(r=-0.729,-0.865,P<0.001),IL-18(r=-0.711,-0.804,P<0.001),PMN(r=-0.804,-0.967,P<0.001,P<0.001)were negatively correlated with efficacy;multifactorial logistic regression analysis showed that after 5 days of treatment,after IL-1β,IL-18,and PMN were all relevant influencing factors for efficacy after 7 days of treatment(P<0.05).Conclusion The changes of IL-1β,IL-18 and PMN in the course of antibacterial treatment of severe CRKP infection in elderly patients are related to the efficacy.Combined detection is expected to become a biomarker for predicting the response of patients to treatment,thereby providing reference for clinical treatment.