血清白细胞介素36相关因子水平对吉兰-巴雷综合征患者预后的预测价值

Predictive value of serum IL-36 family cytokines for prognosis of patients with Guillain-Barre syndrome

目的探讨血清白细胞介素(IL)-36相关因子水平对吉兰-巴雷综合征(GBS)患者预后的预测价值。方法回顾性选取2020年12月至2023年1月湘雅常德医院神经内科收治的GBS患者176例,根据随访6个月时Hughes评分分为预后良好组92例和预后不良组84例。比较2组患者一般临床资料,并检测IL-36α、IL-36β、IL-36γ和IL-36Ra等IL-36相关因子水平,多因素logistic回归分析GBS患者预后不良的影响因素,绘制ROC曲线分析相关因素的预测价值。结果2组年龄、肌电图损伤类型、住院时间、呼吸辅助通气情况比较,差异有统计学意义(P<0.05,P<0.01)。预后不良组IL-36α、IL-36β和IL-36γ水平显著高于预后良好组,IL-36Ra水平显著低于预后良好组(P<0.01)。多因素logistic回归分析显示,年龄、呼吸辅助通气情况、肌电图损伤类型(髓鞘及轴索均受损)、IL-36γ、IL-36Ra水平是GBS患者预后不良的独立影响因素(P<0.05,P<0.01)。ROC曲线分析显示,IL-36γ、IL-36Ra和二者联合曲线下面积分别为0.674(95%CI:0.599~0.742)、0.862(95%CI:0.803~0.910)、0.888(95%CI:0.832~0.931)。校准曲线结果显示,IL-36γ和IL-36Ra水平联合模型预测GBS患者预后不良的发生风险与实际风险一致性较好。结论年龄、呼吸辅助通气情况、肌电图损伤类型(髓鞘及轴索均受损)、IL-36γ、IL-36Ra水平是GBS患者预后不良的独立影响因素,二者联合对GBS患者预后不良具有较好的预测价值,有待作为预测GBS患者预后的有效指标。

Objective To explore the prognostic value of serum interleukin-36(IL-36)family cytokines in patients with Guillain-Barre syndrome(GBS).Methods A retrospective trial was conducted on 176 GBS patients admitted to our hospital from December 2020 to January 2023.According to their Hughes score at 6 months'follow-up,they were divided into good prognosis group(n=92)and poor prognosis group(n=84).Their general data were collected,and the levels of IL-36 family cytokines,such as IL-36α,IL-36β,IL-36γand IL-36Ra were detected.Multivariate logistic regression analysis was employed to identify the influencing factors for poor prognosis of GBS patients,and ROC curve was plotted to analyze the predictive values of related factors.Results There were significant differences in age,injury types by electromyography(EMG),length of hospital stay and respiratory assisted ventilation between the two groups(P<0.05,P<0.01).The levels of IL-36α,IL-36βand IL-36γwere obviously higher while that of IL-36Ra was notably lower in the poor prognosis group than the good prognosis group(P<0.01).Multivariate logistic regression analysis showed that age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and serum IL-36γand IL-36Ra levels were independent influencing factors for poor prognosis of GBS patients(P<0.05,P<0.01).ROC curve analysis indicated that the AUC value of IL-36γ,IL-36Ra and their combination was 0.674(95%CI:0.599-0.742),0.862(95%CI:0.803-0.910)and 0.888(95%CI:0.832-0.931),respectively.Calibration positive curve analysis showed that the combined model of IL-36γand IL-36Ra levels presented good consistency with the actual risk in predicting the risk of poor prognosis in GBS patients.Conclusion Age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and IL-36γand IL-36Ra levels are independently risk factors for poor prognosis of GBS patients.The combination of IL-36γand IL-36Ra levels has a good predictive value for poor prognosis of GBS patients,and can be used as an effective indicator for the prediction.