IL-6、IL-10、TNF-α对肠穿孔相关脓毒症预后的预测价值  

Prognostic value of IL-6,IL-10 and TNF-αin intestinal perforation-related sepsis

作　　者：陈灵涛 陈鹏[1,2] 赵辉 CHEN Lingtao;CHEN Peng;ZHAO Hui(Department of Emergency,Taizhou Hospital of Zhejiang Province,Zhejiang,Taizhou 318050,China;Department of Emergency,Enze Hospital,Taizhou Enze Medical Center(Group),Zhejiang,Taizhou 318050,China;Department of Critical Care Medicine,Taizhou Hospital of Zhejiang Province,Zhejiang,Taizhou 318050,China)

机构地区：[1]浙江省台州医院急诊科,浙江台州318050 [2]台州恩泽医疗中心(集团)恩泽医院急诊科,浙江台州318050 [3]浙江省台州医院重症医学科,浙江台州318050

出　　处：《中国现代医生》2022年第31期35-38,43,共5页China Modern Doctor

基　　金：台州市科技局科技计划项目(21ywb25,20ywa50)。

摘　　要：目的探讨白细胞介素(interleukin,IL)-6、IL-10和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)对肠穿孔相关脓毒症预后的预测价值。方法选取2017年1月至2021年12月台州恩泽医疗中心(集团)恩泽医院急诊监护室救治的肠穿孔相关脓毒症患者152例纳入研究,根据入院28d的存活情况将纳入患者分为存活组(n=114)和死亡组(n=38),比较患者术前(D0)、术后第1天(D1)、第2天(D2)的IL-6、IL-10、TNF-α、降钙素原(procalcitonin,PCT)及C反应蛋白(C-reactive protein,CRP)水平,采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评估上述炎症因子及其变化值对肠穿孔相关脓毒症患者预后的预测价值。结果死亡组患者D0、D1、D2的IL-6、IL-10、TNF-α、PCT水平均显著高于同期存活组(P<0.05),存活组患者的Δ%IL-6、Δ%IL-10、Δ%TNF-α、Δ%PCT及Δ%CRP均显著大于死亡组(P<0.05)。ROC曲线结果显示,IL-6_((D0))、IL-10_((D0))、TNF-α_((D0))、PCT_((D0))、Δ%IL-6、Δ%IL-10、Δ%TNF-α、Δ%PCT、Δ%CRP预测肠穿孔相关脓毒症患者预后的曲线下面积(area under the curve,AUC)分别为0.842、0.802、0.859、0.637、0.903、0.954、0.965、0.919、0.768,其中Δ%TNF-α的AUC最大,敏感度为92%,特异性为100%。结论炎症因子及其变化值对肠穿孔相关脓毒症患者的预后均有一定的预测价值,可为临床诊治提供参考依据。Objective To study the prognostic value of interleukin(IL)-6,IL-10 and tumor necrosis factor-α(TNF-α)in intestinal perforation-related sepsis.Methods From January 2017 to December 2021,152 patients with intestinal perforation-related sepsis treated in Enze Hospital,Taizhou Enze Medical Center(Group)were included in the study.The patients were divided into survival group(114 cases)and death group(38 cases)according to their 28-day survival.The levels of IL-6,IL-10,TNF-α,procalcitonin(PCT)and C-reactive protein(CRP)were compared before operation(D0),the first day(D1)and the second day(D2)after operation,receiver operator characteristic(ROC)curve was used to evaluate the prognostic value of these inflammatory factors and their changes in patients with intestinal perforation-related sepsis.Results The levels of IL-6,IL-10,TNF-α,PCT in D0,D1,D2 in death group were significantly higher than those in survival group(P<0.05),the levels ofΔ%IL-6,Δ%IL-10,Δ%TNF-α,Δ%PCT andΔ%CRP in survival group were significantly higher than those in death group(P<0.05).The ROC curves showed that the area under the curve(AUC)of IL-6_((D0)),IL-10_((D0)),TNF-α_((D0)),PCT_((D0)),Δ%IL-6,Δ%IL-10,Δ%TNF-α,Δ%PCT,Δ%CRP for predicting the prognosis of intestinal perforation-related sepsis were 0.842,0.802,0.859,0.637,0.903,0.954,0.965,0.919,0.768,respectively.The AUC ofΔ%TNF-αwas the largest and had a maximum sensitivity of 92%and a specificity of 100%.Conclusion Inflammatory cytokines and their changes have certain predictive value for the prognosis of patients with intestinal perforation-related sepsis,which can provide reference for clinical diagnosis and treatment.

关 键 词：肠穿孔 脓毒症 白细胞介素-6 白细胞介素-10 肿瘤坏死因子-α 预后 

分 类 号：R687.3[医药卫生—骨科学]