脓毒症早期血清白细胞介素-18和10在疾病严重程度及预后评估中的价值研究  

The value of serum interleukin-18 and 10 in the evaluation of severity and prognosis in the early stage of sepsis

作　　者：孙荣青[1] 张少雷[1] 

机构地区：[1]郑州大学第一附属医院ICU,河南省高等学校临床医学重点学科开放实验室,河南450052

出　　处：《中国危重病急救医学》2011年第5期299-301,共3页Chinese Critical Care Medicine

摘　　要：目的观察脓毒症早期血清白细胞介素（IL-18、IL-10）的动态变化，评价其在脓毒症病情严重程度及死亡风险评估中的应用价值。方法采用前瞻性随机对照研究方法。选择2009年12月至2010年8月住重症监护病房（ICU）72h以上的脓毒症患者38例，同时选取20例非脓毒症患者为对照组；根据28d生存情况将脓毒症患者分为生存组（12例）和死亡组（26例）。记录患者入ICU后24、48、72h的一般资料及实验室检查结果，并留取静脉血，采用酶联免疫吸附法（ELISA）检测血清IL-18、IL-10浓度。结果脓毒症组与对照组患者间生命体征、血常规、肝功能、肾功能、凝血功能、血气分析及电解质比较均无差异。脓毒症组入选后24、48、72hIL-18呈下降趋势，IL-10呈升高趋势，IL-18／IL-10比值呈下降趋势，各时间点均高于对照组。脓毒症患者死亡组IL-18、IL-10水平在24、48、72h均高于存活组CIL-18（ng／L）：108．36±18．54比91．66±21．49，92．13±28．92比54．16±31．76，91．78±17．33比76．04±22．09；IL-10（ng／L）：99．42±12．10比77．20±9．47，103．39±17．24比67．88±18．90，118．99±11．20比99．20±12．46，P〈0．05或P〈0．013；死亡组与存活组脓毒症患者24、48、72hIL-18／IL-10比值均呈下降趋势，但两组间差异无统计学意义（1．09±0．19比1．20±0．32，0．92±0．18比0．98±0．29，0．78±0．15比0．77±0．23，均P〉0．05）。结论脓毒症早期血清IL-18与IL-10浓度升高，且死亡者高于存活者，随病程进展，IL-18呈下降趋势，而IL-10呈上升趋势；血清IL-18和IL-10浓度均可用来评价脓毒症患者的疾病严重程度及预后。Objective To observe the dynamic changes in levels of serum interleukins （IL-18, IL-10） in the early stage of sepsis, and to appraise their values in the evaluation of severity and prognosis of sepsis. Methods Prospective randomized controlled study was conducted. Thirty-eight patients with sepsis who stayed longer than 72 hours in intensive care unit （ICU） from December 2009 to August 2010 were enrolled as sepsis group. At the same time, 20 patients without sepsis served as control group. The patients were classified as survival （n= 12） or death group （n= 26） according to 28-day survival. The clinical laboratory examination data were recorded at 24, 48, 72 hours after admission to the ICU, and venous blood was obtained at the same time. The IL-18, IL-10 levels were determined by enzyme-linked immunosorbent assay （ELISA）. Results The vital signs, blood routine, liver function, renal function, coagulation function, arterial blood gas, and electrolyte showed no significant difference between sepsis group and control group 24, 48, 72 hours after admission, the levels of IL-18 were lowered, IL-10 elevated, the IL-18/IL-10 ratio was lowered in the sepsis group, and all of them were higher than control group at each time point. The levels of IL-18, IL-10 in death group of patients with sepsis were all higher than those of survival group at 24, 48, and 72 hours C IL-18 （ng/L） ： 108.36±18.54 vs. 91.66±21.49, 92.13±28.92 vs. 54. 16±31.76, 91.78 ± 17. 33 vs. 76.04 ± 22.09; IL-10 （ng/L）： 99.42 ± 12.10 vs. 77. 20 ± 9.47, 103.39 ± 17.24 vs. 67.88±18. 90, 118.99 ± 11.20 vs. 99.20＋ 12.46, P〈0.05 or P〈0. 013. IL-18/IL-10 ratios were all lowered in both non-survivors and survivors with sepsis at 24, 48, 72 hours, while the differences were not statistically significant （1. 09±0.19 vs. 1.20＋0.32, 0. 92±0. 18 vs. 0. 98±0. 29, 0. 78±0. 15 vs. 0.77± 0. 23, all P〈0. 05）. Conelusion The levels of serum IL-18, IL-10 were all elevated in the early stage of patients with sepsis

关 键 词：脓毒症 白细胞介素-18 白细胞介素-10 预后 评估 

分 类 号：R459.7[医药卫生—急诊医学]