2型糖尿病合并重症肺部感染Th17/Treg和白细胞介素表达及临床意义  

Expression of Th17/Treg and interleukins in type 2 diabetes mellitus patients complicated with severe pulmonary infection and clinical significance

作　　者：倪文琴[1] 吕铁[1] 俞建娣[2] 俞飞云 严一核[1] NI Wen-qin;LYU Tie;YU Jian-di;YU Fei-yun;YAN Yi-he(Shaoxing People's Hospital,Shaoxing,Zhejiang 312000,China)

机构地区：[1]绍兴市人民医院重症医学科,浙江绍兴312000 [2]绍兴市人民医院手术室,浙江绍兴312000

出　　处：《中华医院感染学杂志》2021年第14期2109-2113,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2020KY975)。

摘　　要：目的分析2型糖尿病(T2DM)合并重症肺部感染患者辅助性T细胞17(Th17)/调节性T细胞(Treg)及白细胞介素(IL)-17、IL-22、IL-10表达水平及临床意义。方法回顾性分析绍兴市人民医院重症医学科152例T2DM合并重症肺部感染患者(合并感染组)及136例无肺部感染T2DM患者(T2DM组)临床资料,并纳入32名同期健康体检者作为对照组。记录合并感染组病原菌分布情况;比较三组Th17/Treg、IL-17、IL-22、IL-10表达水平差异,评估上述指标对T2DM合并重症肺部感染的诊断价值;并记录合并感染组入院28 d临床转归情况,分为生存组及病死组,评估上述指标对预后的预测价值。结果合并感染组患者病原菌以革兰阴性菌居多(60.36%)。三组Th17/Treg、IL-17表达水平比较,均为合并感染组>T2DM组>对照组(P<0.05);三组IL-22、IL-10表达水平比较,均为合并感染组<T2DM组<对照组(P<0.05);经受试者工作特征曲线(ROC)分析,发现Th17/Treg、IL-17、IL-22、IL-10对T2DM合并重症肺部感染均具有较高诊断价值(P<0.05),且4项联合检测诊断价值最高。病死组Th17/Treg、IL-17表达水平高于生存组(P<0.05),IL-22、IL-10表达水平低于生存组(P<0.05),且Th17/Treg、IL-17、IL-22、IL-10对T2DM合并重症肺部感染患者入院28 d死亡均有较高预测价值(P<0.05),4项联合检测预测价值最高。结论入院时T2DM患者外周血Th17/Treg、IL-17、IL-22、IL-10表达水平可尽早诊断合并重症肺部感染,预测患者近期预后情况。OBJECTIVE To analyze the expression levels of helper T cell 17(Th17)/regulatory T cell(Treg),interleukin-17(IL-17),IL-22 and IL-10 in the type 2 diabetes mellitus(T2 DM)patients complicated with severe pulmonary infection and observe the clinical significance.METHODS A total of 152 T2 DM patients complicated with severe pulmonary infection(the co-infection group)and 136 T2 DM patients without pulmonary infection(the T2 DM group)who were treated in Shaoxing People’s Hospital were enrolled in the study,the clinical data of the patients were retrospectively analyzed,meanwhile,32 healthy people who received physical examination were set as the control group.The distribution of pathogens isolated from the patients of the co-infection group was recorded.The levels of Th17/Treg,IL-17,IL-22 and IL-10 were compared among the three groups,the values of the above indexes in diagnosis of the T2 DM complicated with severe pulmonary infection were evaluated;the clinical outcomes of the patients in the co-infection group were recorded after the admission to hospital for 28 days,the patients were divided into the survival group and the death group according to the clinical outcomes,and the values of the above indexes in prediction of prognosis were evaluated.RESULTS The gram-negative bacteria are dominant among the pathogens isolated from the patients in the co-infection group,accounting for 60.36%.The expression levels of Th17/Treg and IL-17 were significantly higher in the co-infection group than in the T2 DM group than in the control group(P<0.05);The expression levels of IL-22 and IL-10 were significantly lower in the co-infection group than in the T2 DM group than in the control group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the values of Th17/Treg,IL-17,IL-22 and IL-10 were significantly higher in diagnosis of T2 DM complicated with severe pulmonary infection(P<0.05),and the diagnostic value of the joint detection of the 4 indexes was the highest.The expression levels of Th17/Treg and IL-1

关 键 词：2型糖尿病 重症肺部感染 辅助性T细胞17/调节性T细胞 白细胞介素 转归 

分 类 号：R587.1[医药卫生—内分泌]