中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
2期
138-142
,共5页
白细胞介素-33%脓毒症%降钙素原
白細胞介素-33%膿毒癥%降鈣素原
백세포개소-33%농독증%강개소원
Interleukin-33%Sepsis%Procalcitonin
目的：通过观察脓毒症患者血浆白细胞介素-33（IL-33）的变化规律，探讨其与感染的关系及对疾病预后的预测价值。方法采用前瞻性单中心单盲临床研究方法，选择2012年5月至2013年1月中国医科大学附属盛京医院重症加强治疗病房（ICU）收治的脓毒症患者40例，并根据全身感染严重程度以及有无器官功能不全，将脓毒症患者分为一般脓毒症、严重脓毒症、感染性休克组3组；按28 d预后将脓毒症患者分为死亡组和存活组。同期选择ICU 11例全身炎症反应综合征（SIRS）患者和10例健康志愿者作为对照。于患者入ICU 3 h内、24 h、5 d取血，采用酶联免疫吸附试验（ELISA）检测降钙素原（PCT）、 IL-33、 IL-6、IL-1β、肿瘤坏死因子-α（TNF-α）及IL-33受体sST2水平，计算急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分；同时记录患者转归、 ICU住院时间、机械通气时间。采用Spearman相关分析脓毒症患者IL-33与各指标的相关性；绘制受试者工作特征曲线（ROC）获得IL-33诊断感染的价值。结果脓毒症患者入ICU时血浆IL-33较健康对照组及SIRS组明显升高（ng/L：15.43±7.22比0.67±0.24、1.25±1.09，均P＜0.01），PCT较SIRS组明显上升〔μg/L：52.23（19.69，73.37）比1.22（0.69，3.73），Z＝-2.447，P＜0.001〕。一般脓毒症、严重脓毒症、感染性休克3组患者随病情加重，APACHEⅡ评分、 PCT、 IL-33逐渐升高，ICU住院时间、机械通气时间逐渐延长（P＜0.05或P＜0.01）。脓毒症患者入ICU 3 h内、24 h、5 d血浆IL-33水平（ng/L）分别为15.43±7.22、11.82±6.16、5.55±2.25（F＝4.823，P＝0.004）；入ICU 3 h内，IL-33与APACHEⅡ评分（r＝0.351，P＝0.031）、 PCT（r＝0.412，P＝0.005）、 IL-6（r＝0.535，P＝0.030）、 IL-1β（r＝0.674，P＝0.030）、TNF-α（r＝0.250，P＝0.030）、 sST2（r＝0.620，P＜0.001）及ICU住院时间（r＝0.296，P＝0.013）、机械通气时间（r＝0.385，P＝0.011）均呈显著正相关。脓毒症存活患者（37例）血浆IL-33水平随疾病治愈呈现逐渐下降趋势（F＝7.798，P＜0.01），死亡患者（3例）则无下降趋势（F＝37.283，P＞0.05）。ROC曲线分析显示IL-33与PCT的ROC曲线下面积（AUC）分别为0.821、0.829。IL-33截断值为13.79 ng/L时的敏感度为74.2%，特异度为79.6%；PCT截断值为4.70μg/L时的敏感度为87.5%，特异度为81.4%。结论脓毒症患者入ICU时血浆IL-33即明显上升，与PCT水平呈正相关，对感染有诊断意义；血浆IL-33与脓毒症严重程度有关，其变化趋势对脓毒症患者的预后有提示意义。
目的：通過觀察膿毒癥患者血漿白細胞介素-33（IL-33）的變化規律，探討其與感染的關繫及對疾病預後的預測價值。方法採用前瞻性單中心單盲臨床研究方法，選擇2012年5月至2013年1月中國醫科大學附屬盛京醫院重癥加彊治療病房（ICU）收治的膿毒癥患者40例，併根據全身感染嚴重程度以及有無器官功能不全，將膿毒癥患者分為一般膿毒癥、嚴重膿毒癥、感染性休剋組3組；按28 d預後將膿毒癥患者分為死亡組和存活組。同期選擇ICU 11例全身炎癥反應綜閤徵（SIRS）患者和10例健康誌願者作為對照。于患者入ICU 3 h內、24 h、5 d取血，採用酶聯免疫吸附試驗（ELISA）檢測降鈣素原（PCT）、 IL-33、 IL-6、IL-1β、腫瘤壞死因子-α（TNF-α）及IL-33受體sST2水平，計算急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分；同時記錄患者轉歸、 ICU住院時間、機械通氣時間。採用Spearman相關分析膿毒癥患者IL-33與各指標的相關性；繪製受試者工作特徵麯線（ROC）穫得IL-33診斷感染的價值。結果膿毒癥患者入ICU時血漿IL-33較健康對照組及SIRS組明顯升高（ng/L：15.43±7.22比0.67±0.24、1.25±1.09，均P＜0.01），PCT較SIRS組明顯上升〔μg/L：52.23（19.69，73.37）比1.22（0.69，3.73），Z＝-2.447，P＜0.001〕。一般膿毒癥、嚴重膿毒癥、感染性休剋3組患者隨病情加重，APACHEⅡ評分、 PCT、 IL-33逐漸升高，ICU住院時間、機械通氣時間逐漸延長（P＜0.05或P＜0.01）。膿毒癥患者入ICU 3 h內、24 h、5 d血漿IL-33水平（ng/L）分彆為15.43±7.22、11.82±6.16、5.55±2.25（F＝4.823，P＝0.004）；入ICU 3 h內，IL-33與APACHEⅡ評分（r＝0.351，P＝0.031）、 PCT（r＝0.412，P＝0.005）、 IL-6（r＝0.535，P＝0.030）、 IL-1β（r＝0.674，P＝0.030）、TNF-α（r＝0.250，P＝0.030）、 sST2（r＝0.620，P＜0.001）及ICU住院時間（r＝0.296，P＝0.013）、機械通氣時間（r＝0.385，P＝0.011）均呈顯著正相關。膿毒癥存活患者（37例）血漿IL-33水平隨疾病治愈呈現逐漸下降趨勢（F＝7.798，P＜0.01），死亡患者（3例）則無下降趨勢（F＝37.283，P＞0.05）。ROC麯線分析顯示IL-33與PCT的ROC麯線下麵積（AUC）分彆為0.821、0.829。IL-33截斷值為13.79 ng/L時的敏感度為74.2%，特異度為79.6%；PCT截斷值為4.70μg/L時的敏感度為87.5%，特異度為81.4%。結論膿毒癥患者入ICU時血漿IL-33即明顯上升，與PCT水平呈正相關，對感染有診斷意義；血漿IL-33與膿毒癥嚴重程度有關，其變化趨勢對膿毒癥患者的預後有提示意義。
목적：통과관찰농독증환자혈장백세포개소-33（IL-33）적변화규률，탐토기여감염적관계급대질병예후적예측개치。방법채용전첨성단중심단맹림상연구방법，선택2012년5월지2013년1월중국의과대학부속성경의원중증가강치료병방（ICU）수치적농독증환자40례，병근거전신감염엄중정도이급유무기관공능불전，장농독증환자분위일반농독증、엄중농독증、감염성휴극조3조；안28 d예후장농독증환자분위사망조화존활조。동기선택ICU 11례전신염증반응종합정（SIRS）환자화10례건강지원자작위대조。우환자입ICU 3 h내、24 h、5 d취혈，채용매련면역흡부시험（ELISA）검측강개소원（PCT）、 IL-33、 IL-6、IL-1β、종류배사인자-α（TNF-α）급IL-33수체sST2수평，계산급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분；동시기록환자전귀、 ICU주원시간、궤계통기시간。채용Spearman상관분석농독증환자IL-33여각지표적상관성；회제수시자공작특정곡선（ROC）획득IL-33진단감염적개치。결과농독증환자입ICU시혈장IL-33교건강대조조급SIRS조명현승고（ng/L：15.43±7.22비0.67±0.24、1.25±1.09，균P＜0.01），PCT교SIRS조명현상승〔μg/L：52.23（19.69，73.37）비1.22（0.69，3.73），Z＝-2.447，P＜0.001〕。일반농독증、엄중농독증、감염성휴극3조환자수병정가중，APACHEⅡ평분、 PCT、 IL-33축점승고，ICU주원시간、궤계통기시간축점연장（P＜0.05혹P＜0.01）。농독증환자입ICU 3 h내、24 h、5 d혈장IL-33수평（ng/L）분별위15.43±7.22、11.82±6.16、5.55±2.25（F＝4.823，P＝0.004）；입ICU 3 h내，IL-33여APACHEⅡ평분（r＝0.351，P＝0.031）、 PCT（r＝0.412，P＝0.005）、 IL-6（r＝0.535，P＝0.030）、 IL-1β（r＝0.674，P＝0.030）、TNF-α（r＝0.250，P＝0.030）、 sST2（r＝0.620，P＜0.001）급ICU주원시간（r＝0.296，P＝0.013）、궤계통기시간（r＝0.385，P＝0.011）균정현저정상관。농독증존활환자（37례）혈장IL-33수평수질병치유정현축점하강추세（F＝7.798，P＜0.01），사망환자（3례）칙무하강추세（F＝37.283，P＞0.05）。ROC곡선분석현시IL-33여PCT적ROC곡선하면적（AUC）분별위0.821、0.829。IL-33절단치위13.79 ng/L시적민감도위74.2%，특이도위79.6%；PCT절단치위4.70μg/L시적민감도위87.5%，특이도위81.4%。결론농독증환자입ICU시혈장IL-33즉명현상승，여PCT수평정정상관，대감염유진단의의；혈장IL-33여농독증엄중정도유관，기변화추세대농독증환자적예후유제시의의。
ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.
