摘要
目的研究白介素-6(IL-6)、IL-8联合降钙素原(PCT)在脓毒症进展及预后中的评估价值。方法回顾性研究153例脓毒症患者,根据患者病情严重程度分为休克组58例和非休克组95例,比较两组患者入院第1天、入院第3天和入院第7天外周血中细胞炎症因子IL-6、IL-8、PCT和CRP的表达水平,并计算患者的急性生理与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)、序贯器官衰竭评分(SOFA);根据入院28 d生存情况分为死亡组(36例)和存活组(117例),比较两组患者间IL-6、IL-8、CRP和PCT的水平;绘制受试者工作特征(ROC)曲线分析IL-6、IL-8和PCT联合对脓毒症进展及预后的评估价值,并分析影响脓毒症预后的危险因素。结果入院第1天,休克组的IL-6、IL-8、CRP、PCT、APACHEⅡ评分和SOFA评分明显高于非休克组(t分别=9.56、3.18、13.52、11.12、2.31、2.97,P均<0.05),且入院第3天和第7天的CRP和PCT水平明显高于非休克组(t分别=3.25、3.47、2.78、3.13,P均<0.05)。入院第1天,与存活组比较,死亡组的IL-6、IL-8和PCT水平明显升高(t分别=2.73、3.41、13.75,P均<0.05)。IL-6、IL-8和PCT单独或联合诊断脓毒症的AUC分别是0.73、0.67、0.63、0.80;IL-6、IL-8和PCT单独或联合检测对脓毒症预后的AUC分别是0.77、0.70、0.67、0.83,IL-6和三者联合检测对脓毒症预后价值明显高于PCT单独检测(Z分别=4.37、6.21,P均<0.05)。脓毒症休克、入院第1天的高IL-6水平是脓毒症预后的危险因素(OR分别=2.30、1.74,P均<0.05)。结论IL-6、IL-8和PCT的动态变化可有效反映脓毒症患者的病情和预后,三者联合检测对脓毒症休克的诊断和预后具有较好的临床价值。
Objective To study the value of interleukin-6(IL-6),IL-8 and procalcitonin(PCT)in the progression and prognosis of sepsis.Methods A total of 153 patients with sepsis were retrospectively analyzed and divided into sep-tic shock group(n=58)and non-shock group(n=95)according to the degree of disease.The levels of IL-6,IL-8,PCT,CRP,and scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assess-ment(SOFA)were significantly calculated on first,third and seventh day of admission.According to whether died within 28 days,they were divided into death group(n=36)and survival group(n=117).The levels of IL-6,IL-8,CRP and PCT were measured.The receiver operating characteristic(ROC)curve was used to analyze the evaluation value of IL-6,IL-8 and PCT for the prognosis and progression of sepsis.The prognostic factors of sepsis were analyzed using univariate and multivariate logistic regression analysis.Results On first day of admission,IL-6,IL-8,CRP and PCT levels,and scores of APACHEⅡand SOFA in septic shock group were higher than those in non-shock group(t=9.56,3.18,13.52,11.12,2.31,2.97,P<0.05).In addition,CRP and PCT levels on third and seventh day in septic shock group were higher than those in non shock group(t=3.25,3.47,2.78,3.13,P<0.05).Fur-thermore,the levels of IL-6,IL-8 and PCT in death group were higher than those in survival group on first day of admission(t=2.73,3.41,13.75,P<0.05).The AUC values of IL-6,IL-8,PCT and combined detection for diagnosing sepsis were 0.73,0.67,0.63 and 0.80,respectively.The AUC of IL-6,IL-8,PCT and combined detection for predicting prognosis of sepsis were 0.77,0.70,0.67 and 0.83,respectively.The values of IL-6 and combined diagnosis of IL-6,IL-8 and PCT were higher than that of PCT in predicting the prognosis of sepsis(Z=4.37、6.21,P<0.05).Logistic analysis showed that septic shock and IL-6 level on admission were the risk factors for the prognosis of sepsis(OR=2.30,1.74,P<0.05).Conclusion IL-6,IL-8,PCT and their combined detection have a
作者
姜燕
徐巍
章喜林
董朝晖
JIANG Yan;XU Wei;ZHANG Xilin(Department of Emergency,The First People’s Hospital of Huzhou,Huzhou 313000,China)
出处
《全科医学临床与教育》
2022年第7期621-624,632,共5页
Clinical Education of General Practice
基金
浙江省自然科学基金探索一般项目(LY22H160026)
湖州市科技局公益性应用研究项目(2021GZB03)。
关键词
脓毒症
休克
炎症因子
降钙素原
诊断
预后
sepsis
shock
inflammatory factors
procalcitonin
diagnosis
prognosis
