中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2012年
2期
111-115
,共5页
烧伤%脓毒症%白细胞介素6%白细胞介素10%预后
燒傷%膿毒癥%白細胞介素6%白細胞介素10%預後
소상%농독증%백세포개소6%백세포개소10%예후
Burns%Sepsis%Interleukin-6%Interleukin-10%Prognosis
目的 观察重度烧伤患者血清IL-6、IL-10含量的变化,探讨其与脓毒症发生及预后的关系. 方法 选择2007年3月-2011年3月笔者单位收治的160例大面积严重烧伤成年患者,伤后(1.0±6.0)h入院.根据患者脓毒症发生及死亡情况,将其分为非脓毒症组112例、脓毒症存活组36例、脓毒症死亡组12例,后2组患者脓毒症发生时间为伤后(9±5)d,脓毒症死亡组于伤后(18±4)d死亡.另选择20例成年健康志愿者作为健康对照组.分别统计比较4组受试人员的年龄、3组患者烧伤总面积和Ⅲ度烧伤面积.于各例患者入院后(伤后1d)至伤后20 d每日采血分离血清,用ELISA法测定IL-6、IL-10含量；同法采集健康对照组人员血液检测此2项指标.受试者一般资料数据采用单因素方差分析,IL-6、IL-10含量数据采用重复测量资料的方差分析及SNK法(q检验).结果 (1)3组烧伤患者与健康对照组人员年龄接近(F =2.090,P＞0.05),2个脓毒症组患者烧伤总面积明显大于非脓毒症组(q检验P值均小于0.05),脓毒症死亡组烧伤总面积明显大于脓毒症存活组(q检验P ＜0.05).2个脓毒症组Ⅲ度面积明显大于非脓毒症组(q检验P值均小于0.05).(2)3组患者伤后1 ～20 d血清IL-6含量均明显高于健康对照组.伤后1～7d3组患者IL-6含量接近(F值为0.188 ～2.897,P值均大于0.05).伤后第4天起非脓毒症组IL-6含量开始下降；13 d起脓毒症存活组IL-6含量逐渐下降,而同期脓毒症死亡组IL-6含量继续升高.伤后8d起,非脓毒症组IL-6含量[第8天为(262±25) pg/mL]明显低于脓毒症存活组[第8天为(287±38) pg/mL,q检验P＜0.05]和脓毒症死亡组[第8天为(299±22) pg/mL,q检验P＜0.05].伤后13 d起,脓毒症存活组IL-6含量[第13天为(300±33) pg/mL]明显低于脓毒症死亡组[第13天为(338±22) pg/mL,q检验P ＜0.05].(3)3组烧伤患者各时相点IL-10含量均高于健康对照组.伤后1～5d,3组烧伤患者该指标水平接近(F值为1.802 ～2.538,P值均大于0.05)；第6天起,非脓毒症组IL-10含量明显低于脓毒症死亡组(q检验P值均小于0.05).伤后第8天,脓毒症存活组IL-10含量为(54±19)pg/mL,显著低于脓毒症死亡组[ (91±23) pg/mL,q检验P＜0.05],根据此结果计算出IL-10含量临界值设为77 pg/mL时,灵敏度(83.33％,10/12)与特异度(91.67％,33/36)之和减1值最大,可用于判断脓毒症结局. 结论 在烧伤患者年龄相近的情况下,脓毒症的发生和结局与烧伤面积、深度有关.血清IL-6、IL-10含量在烧伤脓毒症发病机制中均起重要作用.早期IL-6含量不宜用于判断脓毒症患者预后；早期IL-10含量持续高于77 pg/mL提示患者预后不良.
目的 觀察重度燒傷患者血清IL-6、IL-10含量的變化,探討其與膿毒癥髮生及預後的關繫. 方法 選擇2007年3月-2011年3月筆者單位收治的160例大麵積嚴重燒傷成年患者,傷後(1.0±6.0)h入院.根據患者膿毒癥髮生及死亡情況,將其分為非膿毒癥組112例、膿毒癥存活組36例、膿毒癥死亡組12例,後2組患者膿毒癥髮生時間為傷後(9±5)d,膿毒癥死亡組于傷後(18±4)d死亡.另選擇20例成年健康誌願者作為健康對照組.分彆統計比較4組受試人員的年齡、3組患者燒傷總麵積和Ⅲ度燒傷麵積.于各例患者入院後(傷後1d)至傷後20 d每日採血分離血清,用ELISA法測定IL-6、IL-10含量；同法採集健康對照組人員血液檢測此2項指標.受試者一般資料數據採用單因素方差分析,IL-6、IL-10含量數據採用重複測量資料的方差分析及SNK法(q檢驗).結果 (1)3組燒傷患者與健康對照組人員年齡接近(F =2.090,P＞0.05),2箇膿毒癥組患者燒傷總麵積明顯大于非膿毒癥組(q檢驗P值均小于0.05),膿毒癥死亡組燒傷總麵積明顯大于膿毒癥存活組(q檢驗P ＜0.05).2箇膿毒癥組Ⅲ度麵積明顯大于非膿毒癥組(q檢驗P值均小于0.05).(2)3組患者傷後1 ～20 d血清IL-6含量均明顯高于健康對照組.傷後1～7d3組患者IL-6含量接近(F值為0.188 ～2.897,P值均大于0.05).傷後第4天起非膿毒癥組IL-6含量開始下降；13 d起膿毒癥存活組IL-6含量逐漸下降,而同期膿毒癥死亡組IL-6含量繼續升高.傷後8d起,非膿毒癥組IL-6含量[第8天為(262±25) pg/mL]明顯低于膿毒癥存活組[第8天為(287±38) pg/mL,q檢驗P＜0.05]和膿毒癥死亡組[第8天為(299±22) pg/mL,q檢驗P＜0.05].傷後13 d起,膿毒癥存活組IL-6含量[第13天為(300±33) pg/mL]明顯低于膿毒癥死亡組[第13天為(338±22) pg/mL,q檢驗P ＜0.05].(3)3組燒傷患者各時相點IL-10含量均高于健康對照組.傷後1～5d,3組燒傷患者該指標水平接近(F值為1.802 ～2.538,P值均大于0.05)；第6天起,非膿毒癥組IL-10含量明顯低于膿毒癥死亡組(q檢驗P值均小于0.05).傷後第8天,膿毒癥存活組IL-10含量為(54±19)pg/mL,顯著低于膿毒癥死亡組[ (91±23) pg/mL,q檢驗P＜0.05],根據此結果計算齣IL-10含量臨界值設為77 pg/mL時,靈敏度(83.33％,10/12)與特異度(91.67％,33/36)之和減1值最大,可用于判斷膿毒癥結跼. 結論 在燒傷患者年齡相近的情況下,膿毒癥的髮生和結跼與燒傷麵積、深度有關.血清IL-6、IL-10含量在燒傷膿毒癥髮病機製中均起重要作用.早期IL-6含量不宜用于判斷膿毒癥患者預後；早期IL-10含量持續高于77 pg/mL提示患者預後不良.
목적 관찰중도소상환자혈청IL-6、IL-10함량적변화,탐토기여농독증발생급예후적관계. 방법 선택2007년3월-2011년3월필자단위수치적160례대면적엄중소상성년환자,상후(1.0±6.0)h입원.근거환자농독증발생급사망정황,장기분위비농독증조112례、농독증존활조36례、농독증사망조12례,후2조환자농독증발생시간위상후(9±5)d,농독증사망조우상후(18±4)d사망.령선택20례성년건강지원자작위건강대조조.분별통계비교4조수시인원적년령、3조환자소상총면적화Ⅲ도소상면적.우각례환자입원후(상후1d)지상후20 d매일채혈분리혈청,용ELISA법측정IL-6、IL-10함량；동법채집건강대조조인원혈액검측차2항지표.수시자일반자료수거채용단인소방차분석,IL-6、IL-10함량수거채용중복측량자료적방차분석급SNK법(q검험).결과 (1)3조소상환자여건강대조조인원년령접근(F =2.090,P＞0.05),2개농독증조환자소상총면적명현대우비농독증조(q검험P치균소우0.05),농독증사망조소상총면적명현대우농독증존활조(q검험P ＜0.05).2개농독증조Ⅲ도면적명현대우비농독증조(q검험P치균소우0.05).(2)3조환자상후1 ～20 d혈청IL-6함량균명현고우건강대조조.상후1～7d3조환자IL-6함량접근(F치위0.188 ～2.897,P치균대우0.05).상후제4천기비농독증조IL-6함량개시하강；13 d기농독증존활조IL-6함량축점하강,이동기농독증사망조IL-6함량계속승고.상후8d기,비농독증조IL-6함량[제8천위(262±25) pg/mL]명현저우농독증존활조[제8천위(287±38) pg/mL,q검험P＜0.05]화농독증사망조[제8천위(299±22) pg/mL,q검험P＜0.05].상후13 d기,농독증존활조IL-6함량[제13천위(300±33) pg/mL]명현저우농독증사망조[제13천위(338±22) pg/mL,q검험P ＜0.05].(3)3조소상환자각시상점IL-10함량균고우건강대조조.상후1～5d,3조소상환자해지표수평접근(F치위1.802 ～2.538,P치균대우0.05)；제6천기,비농독증조IL-10함량명현저우농독증사망조(q검험P치균소우0.05).상후제8천,농독증존활조IL-10함량위(54±19)pg/mL,현저저우농독증사망조[ (91±23) pg/mL,q검험P＜0.05],근거차결과계산출IL-10함량림계치설위77 pg/mL시,령민도(83.33％,10/12)여특이도(91.67％,33/36)지화감1치최대,가용우판단농독증결국. 결론 재소상환자년령상근적정황하,농독증적발생화결국여소상면적、심도유관.혈청IL-6、IL-10함량재소상농독증발병궤제중균기중요작용.조기IL-6함량불의용우판단농독증환자예후；조기IL-10함량지속고우77 pg/mL제시환자예후불량.
Objective To observe the changes in serum contents of interleukin-6 (IL-6) and interleukin-10 (IL-10) in patients with severe burn injury,and to investigate their relation with occurrence of sepsis and prognosis of patients. Methods One-hundred and sixty adult patients admitted into our hospital (1.0 ±6.0) h after injury during March 2007 to March 2011 with massive and severe burns were enrolled in the investigation.Patients were divided into non-sepsis group (NS,n =112),sepsis-survival group (SS,n =36),and sepsis-deceased group (SD,n =12 ) based on the occurrence of sepsis and death.Sepsis occurred on post burn day (PBD) 9 ±5 in patients in the latter two groups.Patients died on PBD 18 ±4 in SD group.Twenty healthy adult volunteers were chosen as healthy control group ( HC).The age of subjects for observation among four groups,and total burn area and full-thickness burn area of patients among NS,SS,and SD groups were compared.Serum was isolated from blood samples collected from each patient every day from day of admission till PBD 20 to determine the contents of IL-6 and IL-10 by ELISA,and the same determinations were done in HC group.Data of trial subjects were processed with one-way analysis of variance.Data of IL-6 and IL-10 contents were processed with analysis of variance of repeated measure data and SNK method ( q test). Results (1) There was no significant statistical difference among four groups in age ( F =2.090,P ＞ 0.05).Total burn areas of patients in SS and SD groups were significantly larger than that in NS group ( q test,with P values both below 0.05 ),and total burn area of patients in SD group was obviously larger than that in SS group ( q test,P ＜ 0.05 ). Full-thickness burn areas of patients in SS and SD groups were significantly larger than that in NS group ( q test,with P values both below 0.05 ).(2) Serum contents of IL-6 of patients in NS,SS,and SD groups from PBD 1 to 20 were obviously higher than that of volunteers in HC group.There was no significant statistical difference among NS,SS,and SD groups in serum contents of IL-6 from PBD 1 to 7 (with F value from 0.188 to 2.897,P values all above 0.05).Serum content of IL-6 of patients in NS group decreased from PBD 4.Serum content of IL-6 of patients in SS group decreased gradually from PBD 13,but that in SD group increased continuously at the same time points.Serum contents of IL-6 of patients in NS group [ (262 ± 25) pg/mL on PBD 8 ] were lower than those in SS group [(287±38) pg/mL on PBD8,qtest,P ＜0.05] and SD group [(299 ±22) pg/mL on PBD 8,q test,P ＜0.05] from PBD 8.Serum contents of IL-6 of patients in SS group [ (300 ±33) pg/mL on PBD 13] were obviously lower than those in SD group [(338 ±22) pg/mL on PBD 13,q test,P ＜0.05] from PBD 13. (3) Serum contents of IL-10 of patients in NS,SS,and SD groups were higher than that in HC group at each time point.There was no significant statistical difference among NS,SS,and SD groups in serum contents of IL-6 from PBD 1 to 5 ( with F values from 1.802 to 2.538,P values all above 0.05).Serum content of IL-10 of patients in NS group was obviously lower than that of patients in SD group from PBD 6 ( q test,P values all below 0.05).On PBD 8,serum content of IL-10 of patients in SS group [(54±19) pg/mL] was obviously lower than that in SD group [(91 ±23) pg/mL,qtest,P ＜0.05].The sum of sensitivity (83.33％,10/12) and specificity (91.67％,33/36) minus 1 was maximum when the critical value of IL-10 content was set at 77 pg/mL based on the comparison between SS group and SD group in serum content of IL-10 on PBD 8. Conclusions The occurrence and outcome of sepsis is related to burn area and depth when the patients are in similar age.Serum contents of IL-6 and IL-10 play important roles in the pathogenesis of sepsis after burn.IL-6 content in early stage shall not be used in predicting the prognosis of patients with sepsis.IL-10 continuously higher than 77 pg/mL in early stage forecasts unfavorable prognosis of patient.
