白细胞介素35、降钙素原及SOFA评分对脓毒症病情严重程度及预后的评判价值  

Assessment value of interleukin-35,procalcitonin and sequential organ failure assessment score on the severity and prognosis in sepsis

作　　者：查君敬 方长太[1] 白兆青[1] 程高翔 ZHA Junjing;FANG Changtai;BAI Zhaoqing;CHENG Gaoxiang(ICU,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui 246003,China)

机构地区：[1]安徽医科大学附属安庆医院重症医学科,安徽安庆246003

出　　处：《重庆医学》2019年第9期1535-1538,共4页Chongqing medicine

基　　金：安徽省2017年公益性技术应用研究联动计划项目(1704f0804036);安徽医科大学校科研基金资助(2015xkj069)

摘　　要：目的探讨白细胞介素35(IL-35)、降钙素原(PCT)及序贯器官衰竭评估(SOFA)评分在脓毒症严重程度及预后评判中的价值。方法选择2017年4月至2018年2月在安徽医科大学附属安庆医院重症医学科(ICU)治疗的脓毒症患者54例,在明确诊断后的6～8h测定其IL-35、PCT水平,计算患者的SOFA评分,同时对患者入院28d后的生存结局进行随访记录。根据病情严重程度将患者分为脓毒症组和脓毒症休克组,比较两组患者血清IL-35、PCT水平及SOFA评分,以及两组患者的预后情况;按照入院后28d内的生存结局将脓毒症患者分为死亡组和存活组,比较两组患者间IL-35、PCT水平及SOFA评分;绘制受试者工作曲线(ROC)评价IL-35对脓毒症预后的判断价值。结果与脓毒症组比较,脓毒症休克组IL-35[(0.40±0.06)ng/L vs.(0.35±0.04)ng/L,t=-4.096,P<0.01]、PCT[100.00(8.79,100.00)μg/L vs.3.63(0.50,25.88)μg/L,Z=-3.939,P<0.01]及SOFA评分[13.00(9.75,16.50)分vs.7.00(5.25,11.00)分,Z=-3.630,P<0.01]均明显升高;与存活组相比,死亡组IL-35[(0.41±0.05)ng/L vs.(0.34±0.04)ng/L,t=-5.502,P<0.01]、PCT[93.39(25.82,100.00)μg/L vs.2.67(0.54,15.55)μg/L,Z=-3.856,P<0.001]及SOFA评分[13.00(11.75,16.50)分vs.6.50(5.00,10.00)分,Z=-4.800,P<0.01]均明显升高。采用ROC曲线分析并计算曲线下面积(AUC)值,血清IL-35、PCT及SOFA评分对脓毒症患者预后均具有一定的评估价值(P<0.05),血清IL-35、PCT和SOFA评分的AUC分别为0.873、0.823和0.902。当IL-35截断值为0.40ng/L时的敏感度为66.67%,特异度为91.67%;当PCT截断值为19.64μg/L时的敏感度为83.33%,特异度为77.78%;当SOFA评分截断值为10.50分时,敏感度为83.33%,特异度为80.56%。结论检测脓毒症患者血清IL-35水平有助于早期对脓毒症进行病情严重程度及预后评估,可以为脓毒症的治疗决策提供依据。Objective To evaluate the value of interleukin-35(IL-35),procalcitonin(PCT)and sequential organ failure assessment(SOFA)score and investigate their assessment value for severity and prognosis in patients with sepsis,to providea reference for treatment of sepsis.Methods Fifty-four patients with sepsis in the intensive care unit(ICU)of our hospital from April 2017 to February 2018 were enrolled.The levels of IL-35 and PCT were determined and the SOFA score was calculated within 6-8 hours after a definitive diagnosis.And the clinical outcome was also recorded.The patients were divided into the sepsis group and the septic shock group according to the disease severity,and the values of IL-35,PCT,and SOFA score were compared.After admission for 28 days,the cases were divided into the survival group and the death group and the above indicators were also compared.Receiver operating characteristic(ROC)curve was draw to assess IL-35 in predicting the prognosis of sepsis patients.Results Compared with the sepsis shock group,IL-35[ng/L:0.40±0.06 vs.0.35±0.04,t=-4.096,P<0.01],PCT[μg/L:100.00(8.79,100.00)vs.3.63(0.50,25.88),Z=-3.939,P<0.01],SOFA score[score:13.00(9.75,16.50)vs.7.00(5.25,11.00),Z=-3.630,P<0.01]in the sepsis group significantly increased.Also,IL-35[ng/L:0.41±0.05 vs.0.34±0.04,t=-5.502,P<0.01],PCT[μg/L:93.39(25.82,100.00)vs.2.67(0.54,15.55),Z=-3.856,P<0.01,SOFA score[score:13.00(11.75,16.50)vs.6.50(5.00,10.00),Z=-4.800,P<0.01]were all significantly higher in the death group than the survival group.The area under the ROC curve(AUC)of IL-35,PCT and SOFA score in ROC curve were 0.873,0.823 and 0.902,respectively.When the cut-off value of IL-35 was 0.40 ng/L,the sensitivity was66.67%and the specificity was 91.67%;when the cut-off value of PCT was 19.64μg/L,the sensitivity was83.33%and the specificity was 77.78%;when the cut-off value of SOFA score was 10.50,the sensitivity was83.33%and the specificity was 80.56%.Conclusion The level of IL-35 can help to assess the severity and the prognosis of sepsis,which cou

关 键 词：脓毒症 白细胞介素35 降钙素原 序贯器官衰竭评估评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]