重症肺炎患者血清和肺泡灌洗液中IL-6和IL-10水平的变化及其与预后的相关性

Correlation analysis of IL-6, IL-10 level changes in serum and bronchoalveolar lavage fluid and the prognosis in patients with severe pneumonia

目的观察重症肺炎患者血清和肺泡灌洗液中白介素-6(IL-6)和白介素-10(IL-10)水平的变化,并探讨其与临床预后的关系,为临床治疗提供相关依据。方法选取我院重症医学科2014年10月至2015年12月收治的99例重症肺炎患者为研究对象,依据患者病程第10天的临床转归,将其分为好转组59例和恶化组40例。分别在患者病程第1、5、10天,检测其血清和肺泡灌洗液中IL-6、IL-10的水平,同时统计临床肺部感染评分(CPIS),并分析CPIS评分与IL-6、IL-10的水平的相关性。结果第5天和第10天时,好转组血清中IL-6水平分别为(43.18±16.79)pg/m L和(26.88±7.65)pg/m L,明显低于恶化组的(49.77±14.26)pg/m L和(39.73±8.12)pg/m L;好转组肺泡灌洗液中IL-6水平分别为(70.43±28.65)pg/m L和(35.17±9.81)pg/m L,明显低于恶化组的(81.52±20.14)pg/m L和(72.17±19.81)pg/m L,差异均具有统计学意义(P<0.05);组内比较,好转组和恶化组患者血清和肺泡灌洗液中IL-6水平均随着时间推移出现显著下降,差异均具有统计学意义(P<0.05)。第5天和第10天好转组患者血清中IL-10水平分别为(5.21±1.77)pg/m L和(3.63±1.54)pg/m L,明显低于恶化组的(9.76±3.11)pg/m L和(13.16±3.82)pg/m L,好转组肺泡灌洗液中IL-10水平分别为(7.75±1.8)pg/m L和(4.13±1.21)pg/m L,明显低于恶化组的(12.17±3.26)pg/m L和(15.82±4.88)pg/m L,差异均具有统计学意义(P<0.05);好转组患者血清IL-10随着时间推移逐渐降低,差异均具有统计学意义(P<0.05),而恶化组患者血清和肺泡灌洗液中IL-10的水平则持续性升高,差异均具有统计学意义(P<0.05)。相关性分析结果显示,CPIS评分与血清和肺泡灌洗液中IL-6、IL-10的水平均呈明显的正相关(95%CI=0.811 8~0.999 2,P=0.001 8;95%CI=0.953 9~0.999 8,P=0.000 2)。结论动态监测重症肺炎患者血清和肺泡灌洗液中IL-6、IL-l0的水平及变化趋势,能够反映患者预后情况,值得在临床中借鉴和推广。

Objective To investigate the relationship between the changes of interleukin-6(IL-6), interleukin-10(IL-10) levels in serum and bronchoalveolar lavage fluid and the clinical prognosis, in order to provide basis for clinical treatment. Methods Ninety-nine patients of severe pneumonia admitted to our hospital from October 2014 to December 2015 were selected as research subjects. According to the clinical outcome in 10 d, the patients were divided into improved group(59 cases) and deteriorated group(40 cases). The IL-6, IL-10 levels in serum and bronchoalveolar lavage fluid were detected on the first, 5thand 10 thday, and clinical pulmonary infection scores(CPIS) were statistically recorded. The correlation between CPIS score and IL-6, IL-10 levels was analyzed. Results On the 5thand 10 thday, the serum IL-6 levels of improved group((43.18±16.79) pg/m L,(26.88±7.65) pg/m L) were significantly lower than those of deteriorated group((49.77±14.26) pg/m L,(39.73±8.12) pg/m L). The IL-6 levels in bronchoalveolar lavage fluid of improved group were((70.43 ± 28.65) pg/m L,(35.17 ± 9.81) pg/m L) were significantly lower than those of deteriorated group((81.52±20.14) pg/m L,(72.17±19.81) pg/m L), with P<0.05. The within-group comparison results showed that the IL-6 levels in the serum and bronchoalveolar lavage fluid decreased significantly with time in the two groups, and the differences were statistically significant(P<0.05). On the 5thday and 10 thday, the IL-10 levels of improved group((5.21±1.77) pg/m L,(3.63±1.54) pg/m L) were significantly lower than those of deteriorated group((9.76±3.11) pg/m L,(13.16±3.82) pg/m L), and the IL-10 levels in bronchoalveolar lavage fluid of improved group((7.75±1.8) pg/m L,(4.13±1.21) pg/m L) were significantly lower than those of deteriorated group((12.17±3.26) pg/m L,(15.82±4.88) pg/m L), with statistically significant differences(P<0.05). Within-group comparison showed that the serum IL-10 levels of improved group were decreased gradually with time, and the IL-10 levels of serum and bronchoalveolar lavage fluid in deteriorated group continued to increase, with statistically significant differences(P<0.05). Correlation analysis showed that CPIS score was significantly positively correlated with IL-6 and IL-10 levels in serum and bronchoalveolar lavage fluid(95%CI=0.811 8~0.999 2, P=0.001 8; 95% CI=0.953 9~0.999 8, P=0.000 2). Conclusion The dynamic monitoring of IL-6and IL-10 levels in serum and bronchoalveolar lavage fluid of patients with severe pneumonia can reflect the prognosis of patients, which is worth learning and promotion in clinical practice.