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
6期
460-464
,共5页
付君静%王拥涛%曾萍%牛珊珊
付君靜%王擁濤%曾萍%牛珊珊
부군정%왕옹도%증평%우산산
脓毒症%生物标志物%白细胞介素-27%降钙素原%感染
膿毒癥%生物標誌物%白細胞介素-27%降鈣素原%感染
농독증%생물표지물%백세포개소-27%강개소원%감염
Sepsis%Biomarker%Interleukin-27%Procalcitonin%Infection
目的：评估白细胞介素-27（IL-27）对成人脓毒症危重患者的诊断价值。方法采用回顾性研究方法，选择2014年3月至11月新乡医学院第一附属医院重症医学科176例全身炎症反应综合征（SIRS）患者，按入院诊断分为非脓毒症组（n＝66）、肺源性脓毒症组（n＝65）和非肺源性脓毒症组（n＝45）。采用酶联免疫吸附试验（ELISA）检测各组患者血清IL-27和降钙素原（PCT）水平；绘制受试者工作特征曲线（ROC）判断各指标的诊断价值，并构建分类回归树，分析各生物标志物的性能，判断潜在的预测变量。结果肺源性脓毒症患者体温符合SIRS标准的比例明显高于非脓毒症患者（66.2%比44.5%，P＜0.05），且更易引发肿瘤合并症（44.6%比22.7%，P＜0.05）；非肺源性脓毒症患者白细胞数符合SIRS标准的比例明显高于非脓毒症患者（68.9%比42.7%，P＜0.05），说明肺源性和非肺源性脓毒症患者较非脓毒症患者更加符合SIRS标准。ROC曲线显示， IL-27和PCT都不能从具备SIRS症状的脓毒症患者中诊断出脓毒症患者，ROC曲线下面积（AUC）分别为0.59〔95%可信区间（95%CI）＝0.49～0.65〕和0.61（95%CI＝0.55～0.71）；根据不同感染源进一步分析显示，IL-27在非肺源性脓毒症患者中的AUC最大，但仅为0.71（95%CI＝0.59～0.79）。在非肺源性脓毒症患者中，基于IL-27、PCT和年龄构建分类回归树的AUC为0.78（95%CI＝0.71～0.87），明显大于IL-27〔0.71（95%CI＝0.59～0.79）〕或PCT〔0.65（95%CI＝0.57～0.78）〕。与文献报道的脓毒症患儿比较，成人脓毒症患者IL-27水平较低。结论 IL-27作为脓毒症诊断的生物标志物，对病情变化的反应不敏感，其用于脓毒症患儿的诊断较成人更实用；而IL-27和PCT结合更适于确定非肺源性脓毒症成人患者由SIRS发展为脓毒症的风险。
目的：評估白細胞介素-27（IL-27）對成人膿毒癥危重患者的診斷價值。方法採用迴顧性研究方法，選擇2014年3月至11月新鄉醫學院第一附屬醫院重癥醫學科176例全身炎癥反應綜閤徵（SIRS）患者，按入院診斷分為非膿毒癥組（n＝66）、肺源性膿毒癥組（n＝65）和非肺源性膿毒癥組（n＝45）。採用酶聯免疫吸附試驗（ELISA）檢測各組患者血清IL-27和降鈣素原（PCT）水平；繪製受試者工作特徵麯線（ROC）判斷各指標的診斷價值，併構建分類迴歸樹，分析各生物標誌物的性能，判斷潛在的預測變量。結果肺源性膿毒癥患者體溫符閤SIRS標準的比例明顯高于非膿毒癥患者（66.2%比44.5%，P＜0.05），且更易引髮腫瘤閤併癥（44.6%比22.7%，P＜0.05）；非肺源性膿毒癥患者白細胞數符閤SIRS標準的比例明顯高于非膿毒癥患者（68.9%比42.7%，P＜0.05），說明肺源性和非肺源性膿毒癥患者較非膿毒癥患者更加符閤SIRS標準。ROC麯線顯示， IL-27和PCT都不能從具備SIRS癥狀的膿毒癥患者中診斷齣膿毒癥患者，ROC麯線下麵積（AUC）分彆為0.59〔95%可信區間（95%CI）＝0.49～0.65〕和0.61（95%CI＝0.55～0.71）；根據不同感染源進一步分析顯示，IL-27在非肺源性膿毒癥患者中的AUC最大，但僅為0.71（95%CI＝0.59～0.79）。在非肺源性膿毒癥患者中，基于IL-27、PCT和年齡構建分類迴歸樹的AUC為0.78（95%CI＝0.71～0.87），明顯大于IL-27〔0.71（95%CI＝0.59～0.79）〕或PCT〔0.65（95%CI＝0.57～0.78）〕。與文獻報道的膿毒癥患兒比較，成人膿毒癥患者IL-27水平較低。結論 IL-27作為膿毒癥診斷的生物標誌物，對病情變化的反應不敏感，其用于膿毒癥患兒的診斷較成人更實用；而IL-27和PCT結閤更適于確定非肺源性膿毒癥成人患者由SIRS髮展為膿毒癥的風險。
목적：평고백세포개소-27（IL-27）대성인농독증위중환자적진단개치。방법채용회고성연구방법，선택2014년3월지11월신향의학원제일부속의원중증의학과176례전신염증반응종합정（SIRS）환자，안입원진단분위비농독증조（n＝66）、폐원성농독증조（n＝65）화비폐원성농독증조（n＝45）。채용매련면역흡부시험（ELISA）검측각조환자혈청IL-27화강개소원（PCT）수평；회제수시자공작특정곡선（ROC）판단각지표적진단개치，병구건분류회귀수，분석각생물표지물적성능，판단잠재적예측변량。결과폐원성농독증환자체온부합SIRS표준적비례명현고우비농독증환자（66.2%비44.5%，P＜0.05），차경역인발종류합병증（44.6%비22.7%，P＜0.05）；비폐원성농독증환자백세포수부합SIRS표준적비례명현고우비농독증환자（68.9%비42.7%，P＜0.05），설명폐원성화비폐원성농독증환자교비농독증환자경가부합SIRS표준。ROC곡선현시， IL-27화PCT도불능종구비SIRS증상적농독증환자중진단출농독증환자，ROC곡선하면적（AUC）분별위0.59〔95%가신구간（95%CI）＝0.49～0.65〕화0.61（95%CI＝0.55～0.71）；근거불동감염원진일보분석현시，IL-27재비폐원성농독증환자중적AUC최대，단부위0.71（95%CI＝0.59～0.79）。재비폐원성농독증환자중，기우IL-27、PCT화년령구건분류회귀수적AUC위0.78（95%CI＝0.71～0.87），명현대우IL-27〔0.71（95%CI＝0.59～0.79）〕혹PCT〔0.65（95%CI＝0.57～0.78）〕。여문헌보도적농독증환인비교，성인농독증환자IL-27수평교저。결론 IL-27작위농독증진단적생물표지물，대병정변화적반응불민감，기용우농독증환인적진단교성인경실용；이IL-27화PCT결합경괄우학정비폐원성농독증성인환자유SIRS발전위농독증적풍험。
Objective To evaluate interleukin-27 ( IL-27 ) as a sepsis diagnostic biomarker in critically ill adults with sepsis. Methods A retrospetive study was conducted. A total of 176 systemic inflammatory response syndrome ( SIRS ) patients in Department of Critical Care Medicine of Xinxiang Medical College First Affiliated Hospital from March to November in 2014 were enrolled. The patients were divided into no sepsis group ( n=66 ), pulmonary originated sepsis group ( n=65 ), and non-pulmonary originated sepsis group ( n=45 ). Plasma IL-27 and procalcitonin ( PCT ) were determined with enzyme linked immunosorbent assay ( ELISA ). Receiver operating characteristic curve ( ROC ) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance. Results The proportion of patients in pulmonary original sepsis group whose body temperature in line with SIRS criteria was significantly higher than no sepsis group ( 66.2%vs. 44.5%, P<0.05 ), and they were easy to suffer from tumor ( 44.6%vs. 22.7%, P<0.05 ). The proportion of patients in non-pulmonary originated sepsis group whose white blood cell count in line with SIRS criteria was significantly higher than no sepsis group ( 68.9%vs. 42.7%, P<0.05 ). It indicated that patients in pulmonary originated sepsis group and non-pulmonary originated sepsis group were more in line with SIRS criteria compared with no sepsis group. It was shown by ROC curve that IL-27 and PCT was not effective in discriminating sepsis among unselected patients showing symptoms and signs of SIRS. The area under the curve ( AUC ) was 0.59 [ 95%confidence interval ( 95%CI )=0.49-0.65 ] and 0.61 ( 95%CI=0.55-0.71 ). According to the further analysis from different infection sources, the highest AUC was 0.71 ( 95%CI=0.59-0.79 ) for IL-27 in patients with a non-pulmonary originated sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.78 ( 95%CI = 0.71-0.87 ) in patients with a non-pulmonary originated sepsis, which was higher than IL-27 [ 0.71 ( 95%CI = 0.59-0.79 ) ] or PCT [ 0.65 ( 95%CI = 0.57-0.78 ) ]. Compared to that of pediatric cohort with sepsis, lower expression of IL-27 was found in adult patients. Conclusions IL-27 performed overall poorly as a sepsis diagnostic biomarker in adults. IL-27 may be a more reliable diagnostic biomarker for sepsis in children than in adults. The combination of IL-27 and PCT can reasonably estimate the risk of sepsis in subjects with a non-pulmonary originated sepsis.
