白细胞介素-33在脓毒症中的变化及其与疾病严重程度的相关性分析  

Changes in plasma interleukin-33 concentration in sepsis and its correlation with seriousness of sepsis

作　　者：常玓[1] 贾佳[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110004

出　　处：《中华危重病急救医学》2015年第2期138-142,共5页Chinese Critical Care Medicine

基　　金：基金项目：辽宁省自然科学基金项目（201102293）

摘　　要：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-般脓毒症、严重脓毒症、感染性休克组3组；按28d预后将脓毒症患者分为死亡组和存活组。同期选择ICU11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ICU3h内、24h、5d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—18、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。结果脓毒症患者人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]。-般脓毒症、严重脓毒症、感染性休克3组患者随病情加重，APACHEI／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）。脓毒症患者人ICU3h内、24h、5d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）；人ICU3h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-18（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�Objective To 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 evaluation II （APACHE II ） 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, both P 〈 0.01 ）. Compared with SIRS group, PCT in sepsis group was significantly increased [p.g/L： 52.23 （ 19.69, 73.37） vs. 1.22 （0.69, 3.73 ）, Z = -2.447, P 〈 0.001 ]. With exacerbation of illness, APACHE I/ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic

关 键 词：白细胞介素-33 脓毒症 降钙素原 

分 类 号：R459.7[医药卫生—急诊医学]