血清白细胞介素-17A和白细胞介素-10对急诊重症肺炎患者预后的影响

The impact of changes in serum IL-17A and IL-10 levels on the prognosis of emergency severe pneumonia patients

目的探讨血清白细胞介素(IL)-17A和IL-10变化对急诊重症肺炎患者预后的影响。方法对2020年4月至2024年4月山西医科大学附属运城市中心医院重症监护病房(ICU)收治的246例急诊重症肺炎患者的临床资料进行回顾性分析,根据发病后28 d内生存情况将患者分为预后不良组(n=41)和预后良好组(n=205)。比较两组血清IL-17A和IL-10水平变化,分析两指标对急诊重症肺炎患者预后的影响。结果预后不良组改良的肺炎评分(CURB-65)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、有创机械通气占比、白细胞计数、D-二聚体、C反应蛋白、入院时血清IL-17A及IL-10水平均高于预后良好组(P<0.05);Cox回归分析显示,CURB-65评分、APACHEⅡ评分、白细胞计数、C反应蛋白、IL-17A及IL-10均是急诊重症肺炎患者预后不良的影响因素(P均<0.05);预后不良组入院时、入住ICU 24 h和48 h时血清IL-17A和IL-10水平均高于预后良好组(P<0.05);限制性立方样条结果显示,当IL-17A>12.04 pg/mL、IL-10>7.91 pg/mL时,其导致急诊重症肺炎患者预后不良风险显著增加;决策曲线显示,阈值在0.187~0.437时,IL-17A与IL-10联合预测急诊重症肺炎患者预后不良的净收益率均高于两指标的单独预测效能;阈值在0~1.0时,基于Cox回归分析构建的预测模型预测急诊重症肺炎患者预后不良的净收益率均高于IL-17A和IL-10单独及联合的预测效果;血清IL-17A和IL-10对急诊重症肺炎患者预后不良风险具有正向交互作用。结论血清IL-17A和IL-10水平异常升高与重症肺炎患者预后不良有关,其动态变化可提示重症肺炎患者免疫与炎症的失衡状态,且两指标对患者预后不良风险存在正向交互作用。

Objective To analyze the impact of changes in serum interleukin(IL)-17A and IL-10 levels on the prognosis of emergency severe pneumonia patients.Methods A retrospective analysis was conducted on the clinical data of 246 emergency severe pneumonia patients admitted to the intensive care unit(ICU)of Yuncheng Central Hospital Affiliated to Shanxi Medical University from April 2020 to April 2024.Patients were divided into a poor prognosis group(n=41)and a good prognosis group(n=205)based on their survival status within 28 d after onset.The changes of serum IL-17 A and IL-10 levels were compared between the two groups,and the effect of the two indexes on the prognosis of patients with emergency severe pneumonia was analyzed.Results The improved pneumonia score(CURB-65),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,the proportion of invasive mechanical ventilation,white blood cell count,D-dimer,C-reactive protein,and serum IL-17A and IL-10 levels at admission in the poor prognosis group were all higher than those in the good prognosis group(P<0.05).Cox regression analysis showed that CURB-65 score,APACHEⅡscore,white blood cell count,C-reactive protein,IL-17A and IL-10 were all influencing factors for poor prognosis in emergency severe pneumonia patients(all P<0.05).The serum IL-17A and IL-10 levels in the poor prognosis group were higher than those in the good prognosis group at admission,ICU stay for 24 h and 48 h(P<0.05).The results of the restricted cubic spline analysis showed that when IL-17A>12.04 pg/mL and IL-10>7.91 pg/mL,the risk of poor prognosis for emergency severe pneumonia patients significantly increased.The decision curve showed that when the threshold was between 0.187 and 0.437,the net return rate of the combined prediction of IL-17A and IL-10 for predicting poor prognosis was higher than that of the individual indicators(IL-17A or IL-10).When the threshold was between 0 and 1.0,the net return rate of prediction model for predicting poor prognosis based on Cox regression analysis was higher than that of IL-17A,IL-10 alone and in combination.Serum IL-17A and IL-10 had a positive interaction with the risk of poor prognosis in emergency severe pneumonia patients.Conclusions The abnormal elevation of serum IL-17A and IL-10 levels is associated with poor prognosis in the patients with severe pneumonia.Their dynamic changes indicate an imbalance between immune function and inflammatory function in the patients with severe pneumonia,and there is a positive interaction between the two indicators and the risk of poor prognosis in the patients with severe pneumonia.