[1]李 蕊,杨 柳,周 磊,等.脓毒症患者外周血细胞因子，PCT和NLR表达水平及与临床预后价值研究[J].现代检验医学杂志,2024,39(01):67-72+89.[doi:10.3969/j.issn.1671-7414.2024.01.012]
　LI Rui,YANG Liu,ZHOU Lei,et al.Serum Cytokines, PCT and NLR Expression Levels and Their Diagnostic Value in Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2024,39(01):67-72+89.[doi:10.3969/j.issn.1671-7414.2024.01.012]
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脓毒症患者外周血细胞因子，PCT和NLR表达水平及与临床预后价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年01期
页码:
67-72+89
栏目:
论著
出版日期:
2024-01-15

文章信息/Info

Title:
Serum Cytokines, PCT and NLR Expression Levels and Their Diagnostic Value in Patients with Sepsis
文章编号:
1671-7414（2024）01-067-07
作者:
李 蕊; 杨 柳; 周 磊; 刘家云
（空军军医大学第一附属医院，西安 710032）
Author(s):
LI Rui; YANG Liu; ZHOU Lei; LIU Jiayun
（the First Affiliated Hospital of Air Force Medical University, Xi’an 710032, China）
关键词:
脓毒症; 细胞因子; 降钙素原; 中性粒细胞- 淋巴细胞比值
分类号:
R631；R392.11
DOI:
10.3969/j.issn.1671-7414.2024.01.012
文献标志码:
A
摘要:
目的　探讨细胞因子、降钙素原 (procalcitonin，PCT) 及中性粒细胞- 淋巴细胞比值(neutrophil-lymphocyteratio，NLR) 在脓毒症患者早期诊断及预后评价中的价值。方法　选取空军军医大学第一附属医院2020 年1 月～ 2023年1 月收治的98 例脓毒症患者作为研究对象，其中脓毒症休克组16 例和非休克组82 例；另根据患者28 天的生存情况，将其分为生存组(n=82) 和死亡组(n=16)；选取同期95 例非脓毒症感染者作为对照组。采集患者入院24h 内的外周静脉血，检测白细胞介素 (interleukin，IL)-1β，IL-2，IL-4，IL-5，IL-6，IL-8，IL-10，IL-12p70，IL-17，肿瘤坏死因子 (tumornecrosis factor，TNF)-α，干扰素 (interferon，IFN)-γ，IFN-α，PCT 和NLR 的表达水平。应用受试者工作特征(receiveroperator characteristic，ROC) 曲线分析各炎性指标对脓毒症患者诊断及不良预后的预测价值。结果　①脓毒症组除IL-1β 和IFN-γ 外，其余炎性指标均高于非脓毒症感染组，差异具有统计学意义 (Z=0.43 ～ 30.54，均P<0.05)。其中IL-8，NLR，PCT 和IL-17 预测脓毒症的能力较强，曲线下面积(area under curve，AUC) 分别为0.78(95%CI：0.71 ～ 0.84)，0.81(95%CI：0.75 ～ 0.87)，0.83(95%CI：0.78 ～ 0.88)，0.86(95%CI：0.81 ～ 0.92)，联合检测四种指标AUC 可达到0.90(95%CI：0.85 ～ 0.93)，能有效提高诊断效能；②脓毒症血培养阳性组和阴性组的细胞因子，PCT 和NLR 表达水平差异均无统计学意义(P>0.05)，提示这些炎性指标不受血培养检测结果影响；③脓毒症休克组IL-6[122.10(10.77 ～10 000.00)ng/L] 表达水平明显高于非休克组[25.56(1.02 ～ 9 096.74)ng/L]，差异具有统计学意义(Z=74.55，P=0.01)，AUC 为0.73(95%CI 0.59 ～ 0.87)； 死亡组IL-10[10.69(1.12 ～ 1 338.00)ng/L]，IL-2[12.52(0.86 ～ 280.42) ng/L] 和IL-5[9.55(0.93 ～ 259.57)ng/L] 的表达水平均高于生存组 [2.55(0.34 ～ 695.13)ng/L ，4.46(0.13 ～ 625.43) ng/L，2.75(0.01 ～ 117.88)ng/L]，差异具有统计学意义 (Z=3.64，6.37，4.74，均P<0.05)，三者预测脓毒症预后的AUC 分别为0.69(95%CI：(0.53 ～ 0.85) ，0.71(95%CI：0.56 ～ 0.85)，0.72(95%CI：0.58 ～ 0.87)。结论　IL-8，NLR，PCT 和IL-17联合检测有助于脓毒症的早期鉴别诊断，IL-6 表达水平的升高可以有效预警脓毒症休克的发生，IL-10，IL-2 和IL-5 的高表达则对脓毒症患者死亡具有较好的预测价值。
Abstract:
Objective　To explore the value of cytokines，procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR) in the early diagnosis and prognosis evaluation in the patients with sepsis. Methods　98 patients with sepsis admitted to the First Affiliated Hospital of Air Force Medical University from January 2020 to January 2023 were selected as research objects, including 82 patients in the sepsis non-shock group and 16 patients in the sepsis shock group. According to the death within 28 days, the patients was divided into survival group(n=82) and death group(n=16). Meantime, 95 cases of non-septic infection group were included as control. The expression of interleukin (IL)-1β，IL-2，IL-4，IL-5，IL-6，IL-8，IL-10，IL-12p70， IL-17，tumor necrosis factor (TNF)-α，interferon (IFN)-γ，IFN-α，PCT，and NLR were detected within 24h after admission, and their relationship with sepsis was analyzed by ROC curve. Results　① The IL-2，IL-4，IL-5，IL-6，IL-8， IL-10，IL-12p70，IL-17，TNF-α，IFN-α, NLR and PCT in patients with sepsis were significantly higher than those in healthy subjects (Z=0.43 ～ 30.54，all P<0.05) except IL-1β，IFN-γ. Further analysis of ROC showed that IL-8，NLR， PCT and IL-17 had strong predictive ability, with area under curve (AUC) of 0.78(95%CI：0.71 ～ 0.84), 0.81(95%CI：0.75 ～ 0.87), 0.83(95%CI：0.78 ～ 0.88), 0.86(95%CI：0.81 ～ 0.92), respectively. Combined detection of the four indicators can effectively improve the diagnostic efficiency of sepsis, with the AUC of 0.90(95%CI：0.85 ～ 0.93). ② There were no significant differences in cytokines，PCT and NLR concentration between positive and negative blood culture groups (P>0.05), suggesting that these indexes were not affected by blood culture detection results. ③ Among the patients in the shock group, IL-6 [122.10(10.77 ～ 10 000.00)ng/L] was significantly higher than that in non-shock group[25.56(1.02 ～ 9 096.74)ng/L], the difference was statistically significant (Z=74.55, P=0.01)，with the AUC of 0.73 (95%CI：0.59 ～ 0.87). The levels of IL- 10[10.69(1.12 ～ 1 338.00)ng/L]，IL-2[12.52(0.86 ～ 280.42)ng/L] and IL-5[9.55(0.93 ～ 259.57)ng/L] in sepsis death group were higher than those [2.55(0.34 ～ 695.13)ng/L，4.46(0.13 ～ 625.43)ng/L，2.75 (0.01 ～ 117.88)ng/L] in survival group, the differences were statistically significant (Z=3.64, 6.37, 4.74, all P<0.05), and the AUC were 0.69 (95%CI：0.53 ～ 0.85), 0.71(95%CI：0.56 ～ 0.85) and 0.72(95%CI：0.58 ～ 0.87), respectively. Conclusion　The combined detection of IL-8, NLR, PCT and IL-17 is helpful for the early diagnosis of sepsis. The increase of IL-6 level can effectively predict the occurrence of septic shock, and the high expression of IL-10, IL-2 and IL-5 has a good predictive value for the death of sepsis patients.

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备注/Memo

备注/Memo:
作者简介：李蕊(1988-)，女，硕士，主管技师，研究方向：临床分子生物学，E-mail：lirui10305566@126.com。
通讯作者：刘家云，男，主任医师/ 教授，研究方向：病原分子生物学，E-mail：jiayun@fmmu.edu.cn。
更新日期/Last Update: 2024-01-15