文章摘要
程高翔,方长太,查君敬,等.白细胞介素-35在脓毒症病情评估及预后中的应用[J].安徽医药,2017,21(4):672-675.
白细胞介素-35在脓毒症病情评估及预后中的应用
Application research ofInterleukin-35 in sepsis correlated withcondition evaluation and prognosis
投稿时间:2016-11-01  
DOI:
中文关键词: 白细胞介素-35  脓毒症  降钙素原  免疫  调节性T细胞
英文关键词: Interleukin-35  Sepsis  Procalcitonin  Immune  Treg
基金项目:安徽医科大学校科研基金(2015xkj069)
作者单位E-mail
程高翔 安徽医科大学附属安庆医院重症医学科,安徽 安庆 246000  
方长太 安徽医科大学附属安庆医院重症医学科,安徽 安庆 246000 fangchangtai@163.com 
查君敬 安徽医科大学附属安庆医院重症医学科,安徽 安庆 246000  
黄利娟 安徽医科大学附属安庆医院重症医学科,安徽 安庆 246000  
陈园园 安徽医科大学附属安庆医院重症医学科,安徽 安庆 246000  
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中文摘要:
      目的 通过观察脓毒症病人血清白细胞介素-35(IL-35)的变化规律,探讨其与感染的关系及对疾病预后的影响。方法 采用前瞻性研究方法,选择67例脓毒症病人为脓毒症组;同时选择符合全身炎性反应综合征(SIRS)但无感染病人(30例)以及健康志愿者(30例)作为对照。于病人入重症医学科(ICU) 3 h内取血,采用酶联免疫吸附试验(ELISA)检测IL-35、降钙素原(PCT),并计算急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分,根据病人入院后28 d生存结局,比较存活组(57例)与死亡组(40例)病人之间IL-35水平的差异。采用多种非参数方法分析脓毒症病人IL-35 与上述指标的相关性;获得IL-35诊断脓毒症及预后判断的价值。结果 脓毒症病人血清IL-35较SIRS组及健康对照组明显升高[0.43(0.25)比0.24(0.09)、0.15(0.00)ng·L-1,Z=7.862,P<0.01],PCT较SIRS组明显升高[6.92(23.44)比2.09(1.53)μg·L-1,Z=-2.038,P<0.05],健康组、SIRS组,脓毒症组的APACHE Ⅱ评分、PCT、IL-35水平随疾病严重程度加深而升高,且脓毒症组IL-35 与 APACHE Ⅱ评分(r=0.587,P<0.001)、PCT(r=0.691,P<0.001)均呈显著正相关,此外,ROC分析知:以IL-35=0.30 ng·L-1为阈值,其预测死亡预后的灵敏度=0.722,特异性=0.759,曲线下面积AUC=0.735,提示IL-35对脓毒症预后预测价值较好。结论 脓毒症病人血清IL-35 较SIRS组及健康对照组明显上升,且与 PCT 水平呈正相关,对感染有诊断意义;血清IL-35与APACHE Ⅱ评分呈正相关,故其水平随APACHE Ⅱ评分升高而升高,而且死亡组IL-35水平较存活组明显升高,IL-35水平的高低对脓毒症病人的预后有重要提示意义。
英文摘要:
      Objective To observe the changes ofinterleukin-35 (IL-35) in sepsis patients′serumfor finding the relationship of the levels of IL-35 and the infection,and the significance of IL-35 in predicting the prognosis of sepsis.Methods A prospective clinical study was conducted.Sixty-seven patients with sepsis were enrolled.Thirty healthy volunteers and thirty patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups.The levels of IL-35,procalcitonin (PCT) were determined byenzyme linked immunosorbent assay (ELISA) within 3 h after admittedto ICU.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated.Then,the patients were assigned into 28-daydeath group and survival group,and the levels of IL-35 were compared.The relationship between the levels of IL-35 and each parameter was analyzed byvarious non-parametric methods.The multi-factor Logistic regression analysiswas used in the diagnosis of sepsis severity and prognosis of independent factors.Results Serum IL-35 in sepsis patients was significantly increased compared with that of the control group[ng·L-1:0.43(0.25):0.24(0.09),0.15(0.00),Z=7.862,P<0.01].PCT was significantly increased compared with that of the SIRS group[μg·L-1:6.92(23.44):2.09(1.53),Z=-2.038,P<0.05].With exacerbation of illness,APACHE Ⅱ score,the values of PCT and the level of IL-35 were gradually increased,Both IL-35 and APACHE Ⅱ or PCT hadsignificant positive correlation(r=0.587,P<0.001 or r=0.691,P<0.001).Besides,from ROC curve,the threshold of IL-35 was 0.30 ng·L-1,the sensitivity of prognosis of death was 0.722,the specificity was 0.759,the area under the ROC curve was 0.735,which promptedthat IL-35 hadgood prognostic values to sepsis.Conclusions The level of Serum IL-35 in sepsis patientswas increased compared withthe SIRS groupand healthy control group,and ithas positive correlation with PCT,which playsimportantrole in diagnosing infection.The level of serum IL-35 in sepsis patients has positive correlation with APACHE Ⅱ.With the increasing of APACHE Ⅱ,the levels of IL-35 are increased andit in death group issignificantly increased than alivegroup,and it has important significance to the prognosis of patients with sepsis.
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