炎症风暴下免疫障碍性脓毒症脑病患者转归的研究及细胞因子联合检测的临床意义

Outcome study of patients with immunodysplastic sepsis associated encephalopathy under inflammatory storm and clinical significance of combined cytokine detection

目的探讨细胞因子联合检测在脓毒症免疫状态识别及脓毒症脑病的风险预示、早期诊断、临床治疗、预后判断的临床运用价值。方法将符合纳入标准的20例脓毒症患者和20例脓毒症脑病患者设为观察A组和观察B组,另选取20例非脓毒症感染性疾病患者设为对照组。观察组患者均接受基于SSC脓毒症指南的标准化治疗方案,根据细胞因子检测结果采取相应的抗炎和(或)免疫调节治疗。比较三组患者感染指标、细胞因子指标、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等临床指标的差别。结果观察A组的IL-6、PCT、CRP水平高于对照组和观察B组(P<0.05),观察B组的IL-10水平高于对照组和观察A组(P<0.05)。与观察A组比较,观察B组入院SOFA评分、APACHEⅡ评分增高,GCS评分减低(P<0.05)。根据检测结果采取相应的抗炎和(或)免疫调节治疗,结果提示观察B组出院APACHEⅡ评分、SOFA评分较入院时下降,GCS评分较入院时增高(P<0.05)。观察A组和观察B组在出院SOFA评分、APACHEⅡ评分、GCS评分及住院天数间比较差异无统计学意义(P>0.05)。结论细胞因子联合检测对识别脓毒症脑病患者炎症风暴后的免疫状态有重要意义,能够早期协助诊断并指导临床治疗和改善预后。

Objective To explore the clinical application value of cytokine combined detection in immune status recognition of sepsis and risk prediction,early diagnosis,clinical treatment and prognostic judgment of sepsis associated encephalopathy.Methods 20 patients with sepsis and 20 patients with sepsis associated encephalopathy meeting the inclusion criteria were divided into observation group A and observation group B,and 20 patients with non-sepsis infectious diseases were selected as control group.All patients in the observation group received standardized treatment based on SSC sepsis guidelines,and were given anti-inflammatory and/or immunomodulatory therapy according to cytokine detection results.Infection index,cytokine index,SOFA score,APACHEⅡscore were compared among 3 groups.Results The levels of IL-6,PCT and CRP in observation group A were higher than those in control group and observation group B(P<0.05),and the level of IL-10 in observation group B was higher than those in control group and observation group A(P<0.05).Compared with observation group A,SOFA score and APACHEⅡscore were increased and GCS score was decreased in observation group B(P<0.05).According to the results of cytokine detection,anti-inflammatory and/or immunoregulatory treatment were taken accordingly.The results indicated that APACHEⅡscore and SOFA score in observation group B were lower at discharge than at admission,and GCS score was higher than at admission(P<0.05).But there were no statistically significant differences in SOFA score,APACHEⅡscore,GCS score and length of stay between observation group A and observation group B(P>0.05).Conclusion Combined cytokine detection is of great significance for the identification of immune status after inflammatory storm in patients with sepsis associated encephalopathy,which can assist early diagnosis,guide clinical treatment and improve prognosis.