血清IL-10及TNF-α、NF-κB与老年多器官功能不全综合征患者预后的关系

Relationship between serum NF⁃κB,IL⁃10 and TNF⁃αand prognosis in elderly patients with multiple organ dysfunction syndrome

目的探究血清白介素(IL)-10及肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)与老年多器官功能不全综合征(MODSE)患者预后的关系。方法分析2020年1月至2023年1月于上海市宝山区吴淞中心医院收治的82例MODSE患者临床相关资料,并纳入MODSE组,另选取同期40例健康老年体检者作为健康对照组。比较2组血清IL-10及TNF-α、NF-κB mRNA水平差异。另根据发病后28 d临床转归将患者分为存活组(n=50)与死亡组(n=32),以多因素Logistic回归分析影响MODSE患者预后的相关因素,绘制受试者工作特征(ROC)曲线分析血清NF-κB、IL-10及TNF-α对MODSE患者预后不良的预测价值。结果血清IL-10、TNF-α、NF-κB mRNA水平比较,MODSE组均高于健康对照组(χ^(2)=28.511、42.017、12.889,均P<0.05);单因素分析结果显示,存活组与死亡组在受累器官个数、APACHEⅡ评分、血清IL-10、TNF-α、NF-κB mRNA水平上的比较差异有统计学意义(χ^(2)/t=25.719、11.832、4.092、3.903、4.679,均P<0.05);多因素分析显示,APACHEII评分>25,受累器官个数>3,血清IL-10、TNF-α、NF-κB mRNA水平高均为MODSE患者预后不良的独立危险因素(OR=1.998、2.036、2.188、2.230、2.268,均P<0.05);血清IL-10、TNF-α、NF-κB mRNA以及三者联合检测的ROC曲线面积分别为0.739、0.753、0.755以及0.890(均P<0.05)。结论血清NF-κB mRNA、IL-10、TNF-α均与MODSE患者预后不良联系紧密,且三者联合检测对MODSE患者预后具有较好预测价值。

Objective To explore the relationship between serum interleukin-10,tumor necrosis factor-α(TNF-α),nuclear factor-κB(NF-κB)and prognosis in elderly patients with multiple organ dysfunction syndrome(MODSE).Methods The clinical data of 82 MODSE patients admitted to Wusong Central Hospital in Shanghai Baoshan District from January 2020 to January 2023 were retrospectively analyzed.The MODSE group was included,and another 40 healthy elderly patients were selected as the healthy control group.A com-parison was made between the two groups in terms of serum IL-10 and TNF-alpha levels,as well as NF-kappa B mRNA level differences.The patients were further divided into survival(n=50)and death(n=32)groups based on their clinical outcome 28 days after the onset of MODSE.Multivariate logistic regression was used to analyze the factors related to the prognosis of MODSE patients.A receiver operating characteristic(ROC)curve was drawn to assess the predictive value of serum NF-κB,IL-10,and TNF-αfor poor prognosis in MODSE patients.Results Serum IL-10,TNF-α,and NF-κB mRNA levels in the MODSE group were higher than those in the healthy control group(χ^(2)=28.511,42.017,12.889,P<0.05).Univariate analysis showed significant differences between the survival group and the death group in the number of affected organs,APACHEⅡscore,serum IL-10,TNF-α,and NF-κB mRNA levels(χ^(2)/t=25.719,11.832,4.092,3.903,4.679,P<0.05).Multivariate analysis showed that an APACHEⅡscore>25,number of affected organs>3,and high serum IL-10,TNF-αand NF-κB mRNA levels were independent risk factors for a poor prognosis in MODSE patients(OR=1.998,2.036,2.188,2.230,2.268,P<0.05).The ROC curve areas for serum IL-10,TNF-α,NF-κB mRNA,and their combined detection were 0.739,0.753,0.755 and 0.890,respectively(P<0.05).Conclusion Serum NF-κB mRNA,IL-10,and TNF-αare closely associated with a poor prognosis in MODSE patients.The combined de-tection of the three has shown to have a good prognostic value in MODSE patients.