Th1/Th2型细胞因子谱在革兰阴性菌或阳性菌脓毒血症中的鉴别诊断及预后预测价值研究  

Significance of Th1/Th2 cytokine spectrum in differential diagnosis and prognostic prediction of G-/G+bacterial sepsis

作　　者：曾素芬 谢果晋 张素贞 周湧 Zeng Sufen;Xie Guojin;Zhang Suzhen;Zhou Yong(Clinical Laboratory,Dongguan Binhai Bay Central Hospital,Dongguan 523900,China)

机构地区：[1]东莞市滨海湾中心医院检验科,东莞523900 [2]东莞市滨海湾中心医院重症医学科,东莞523900 [3]东莞市虎门中医院检验科,东莞523900

出　　处：《新医学》2023年第4期277-281,共5页Journal of New Medicine

摘　　要：目的研究1型或2型辅助性T淋巴细胞(Th1/Th2)细胞因子谱在革兰阴性菌或革兰阳性菌(G^(-)/G^(+))脓毒血症中的鉴别诊断意义及预后预测价值。方法收集120例脓毒血症患者的临床资料,按照患者的细菌学培养结果分为G^(-)感染组(G^(-)组,65例)和G^(+)感染组(G^(+)组,55例),并根据患者随访28 d时是否生存分为死亡组(41例)和生存组(79例),分别比较G^(-)组和G^(+)组患者、生存组和死亡组中Th1/Th2细胞因子谱IL-2、IL-4、IL-6、IL-10、IFN-γ、TNF-α水平的组间差异。分析IL-6、IL-10、IFN-γ联合检测对G^(-)/G^(+)患者的鉴别诊断及预后评估的价值。结果G^(-)组和G^(+)组患者的IL-2、IL-4以及TNF-α水平比较差异均无统计学意义(P均>0.05),G^(+)组患者的IL-6、IL-10、IFN-γ均低于G^(-)组患者(P均<0.05)。生存组和死亡组患者的IL-2、IL-4以及TNF-α水平比较差异均无统计学意义(P均>0.05),生存组患者的IL-6、IL-10、IFN-γ均低于死亡组患者。IL-6、IL-10、IFN-γ联合检测对鉴别诊断G^(-)/G^(+)感染以及预测患者死亡的特异度高于单一检测;受试者操作特征曲线分析显示,针对G^(+)感染,IL-6、IL-10、IFN-γ诊断临界值分别为72.56、10.58、2.52 ng/L;针对死亡患者,IL-6、IL-10、IFN-γ诊断临界值分别为189.55、77.11、4.89 ng/L。结论Th1/Th2细胞因子谱IL-6、IL-10、IFN-γ水平可用于鉴别诊断G^(-)或G^(+)脓毒血症,并能有效评估患者预后。Objective To study the significance of Th1/Th2 cytokine spectrum in the differential diagnosis and prognostic prediction of Gram-negative/Gram-positive bacterial sepsis.Methods Clinical data of 120 patients with sepsis were collected.According to the bacterial culture results,all patients were divided into the Gram-negative infection(G^(-)group,n=65)and Grampositive groups(G^(+)group,n=55).Based on the 28 d follow-up outcomes,all patients were assigned into the death(n=41)and survival groups(n=79).The Th1/Th2 cytokine profile including interleukin(IL)-2,IL-4,IL-6,IL-10,interferon(IFN)-γand TNF-αwas compared between the G^(-)and G^(+)groups,and between the death and survival groups,respectively.The significance of combined detection of IL-6,IL-10 and IFN-γin the differential diagnosis and prognostic assessment of G^(-)/G^(+)was evaluated.Results There were no significant differences in IL-2,IL-4 and TNF-αlevels between G^(-)and G^(+)groups(all P>0.05),whereas IL-6,IL-10 and IFN-γlevels in the G^(+)group were significantly lower than those of G^(-)group(all P<0.05).There were no significant differences in IL-2,IL-4 and TNF-αlevels between the survival and death groups(all P>0.05),while IL-6,IL-10 and IFN-γlevels in the survival group were lower compared with those in the death group.Combined detection of IL-6,IL-10 and IFN-γyielded higher specificity in the differential diagnosis and prognostic prediction of G^(-)/G^(+)bacterial infection than the detection of single biomarker.ROC curve analysis showed that the diagnostic cut-off values of IL-6,IL-10 and IFN-γwere 72.56,10.58,and 2.52 ng/L for patients infected with G^(+)bacteria,and 189.55,77.11 and 4.89 ng/L in the death group,respectively.Conclusion Th1/Th2 cytokine profile including IL-6,IL-10 and IFN-γcan be used in the differential diagnosis and prognostic evaluation of patients with G^(-)/G^(+)bacterial sepsis.

关 键 词：脓毒血症 细胞感染 辅助性T淋巴细胞 白介素-6 白介素-10 干扰素-γ 鉴别诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]