老年肺部感染并发脓毒症患者MCP-1与HGF和炎症因子的表达水平  

Expression of MCP-1,HGF and inflammatory factors in ederly pulmonary infection patients complicated with sepsis

作　　者：瞿云[1] 张子洲[2] 史志勇[3] 冯铭[3] 沈科 QU Yun;ZHANG Zi-zhou;SHI Zhi-yong;FENG Ming;SHEN Ke(Changzhou Seventh People′s Hospital,Changzhou,Jiangsu 213011,China)

机构地区：[1]常州市第七人民医院感染管理科,江苏常州213011 [2]常州市第七人民医院呼吸科,江苏常州213011 [3]常州市第七人民医院ICU,江苏常州213011

出　　处：《中华医院感染学杂志》2021年第20期3073-3077,共5页Chinese Journal of Nosocomiology

基　　金：常州市科技局基金资助项目(CJ20209030)。

摘　　要：目的探讨老年肺部感染并发脓毒症患者单核细胞趋化蛋白-1(MCP-1)、肝细胞生长因子(HGF)、白细胞介素1受体拮抗剂(IL-1Ra)、白细胞介素-8(IL-8)及IL-10的表达。方法选取2016年7月-2020年7月常州市第七人民医院呼吸重症监护室(RICU)及重症医学科(ICU)诊断为肺部感染致脓毒症的老年患者92例,分别于入住RICU及ICU后第1、3、7天进行序贯性器官功能衰竭(SOFA)评分和急性生理与慢性健康状况(APACHEⅡ)评分,采集外周静脉血检测MCP-1、HGF、IL-1Ra、IL-8和IL-10水平;记录患者入住RICU及ICU后28 d时的生存状态。结果入住RICU或ICU第3天时SOFA评分,APACHEⅡ评分,外周血MCP-1、HGF、IL-1Ra、IL-8和IL-10水平均较第1天明显上升(P<0.05),到第7天时较第3天降低(P<0.05)。入住RICU或ICU第1天的SOFA评分与MCP-1、HGF、IL-1Ra、IL-8、IL-10呈正相关(P<0.05);APACHEⅡ评分与HGF、IL-1Ra、IL-8、IL-10呈正相关(P<0.05)。患者28 d病死率为23.91%(22/92),死亡组入住RICU或ICU第1天的外周血IL-1Ra、IL-8和IL-10高于生存组(P<0.05);入住RICU或ICU第1天外周血IL-1Ra、IL-8和IL-10三者联合预测28 d死亡风险的ROC曲线下面积(AUC)大于IL-1Ra、IL-10单独预测的AUC(P<0.05),与IL-8单独预测的AUC比较无显著差异。结论老年肺部感染致脓毒症患者外周血MCP-1、HGF、IL-1Ra、IL-8和IL-10水平在住入ICU后先升高,随着病情好转后下降;入RICU或ICU首日患者外周血IL-1Ra、IL-8和IL-10水平对预测28 d死亡风险具有较好的应用价值。OBJECTIVE To explore the dynamic changes and clinical significance of peripheral blood monocyte chemoattractant protein-1(MCP-1),hepatocyte growth factor(HGF),interleukin-1 receptor antagonist(IL-1 Ra),interleukin-8(IL-8) and interleukin-10(IL-10) levels in elderly patients with sepsis induced by lung infection.METHODS A total of 92 elderly patients diagnosed as sepsis induced by lung infection in respiratory intensive care unit(RICU) and intensive care unit(ICU) of Changzhou Seventh People′s Hospital from Jul.2016 to Jul.2020 were collected,sequential organ failure assessment(SOFA) and acute physiology and chronic health evaluation II(APACHE II) score were performed on the 1,3 and 7 day after admission to RICU or ICU,respectively.The peripheral venous blood was collected to detect levels of MCP-1,HGF,IL-1 Ra,IL-8 and IL-10.The survival status of patients 28 days after admission to RICU or ICU was recorded.RESULTS The scores of SOFA and APACHE II,levels of peripheral blood MCP-1,HGF,IL-1 Ra,IL-8 and IL-10 increased significantly on the 3 d of admission to RICU or ICU,compared to the 1 st day(P<0.05),while by the 7 th day,they were significantly lower than those on the 3 d after admission(P<0.05).The SOFA score on the 1 st day of admission to RICU or ICU was positively correlated with MCP-1,HGF,IL-1 Ra,IL-8 and IL-10(P<0.05).APACHE II score was positively correlated with HGF,IL-1 Ra,IL-8 and IL-10(P<0.05).The 28-d mortality rate of patients was 23.91%(22/92).On the 1 st day of admission to RICU or ICU,the levels of peripheral blood IL-1 Ra,IL-8 and IL-10 in death group were significantly higher than those in survival group(P<0.05).At 1 d after admission to RICU or ICU,the area under the ROC curve(AUC) of the combination of peripheral blood IL-1 Ra,IL-8 and IL-10 on 1 st day of admission to RICU or ICU for predicting 28 d death risk was significantly greater than that of IL-1 Ra and IL-10 alone(P<0.05),there was no ignificant difference compared with that of IL-8.CONCLUSION The levels of MCP-1,HGF,IL-1 Ra,IL-8 an

关 键 词：肺部感染 脓毒症 单核细胞趋化蛋白-1 肝细胞生长因子 细胞因子 

分 类 号：R459.7[医药卫生—急诊医学]