宿主免疫反应标志物对脓毒症的预测及预后判断价值  

Prediction and prognostic value of host immune response markers in sepsis

作　　者：翁杰[1] 宋佳泽 许哲[3] 田伟华 何董源 林佳颖 杨静雯 王志翊[1,4] WENG Jie;SONG Jiaze;XU Zhe;TIAN Weihua;HE Dongyuan;LIN Jiaying;YANG Jingwen;WANG Zhiyi(Department of General Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;The Second Clinical Medical College,Wenzhou Medical University,Wenzhou 325035,China;Department of Emergency Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of General Medicine,Taizhou Women and Children’s Hospital Affiliated to Wenzhou Medical University,Taizhou 317700,China)

机构地区：[1]温州医科大学附属第二医院全科医学科,浙江温州325027 [2]温州医科大学第二临床医学院,浙江温州325035 [3]温州医科大学附属第二医院急诊医学科,浙江温州325027 [4]温州医科大学附属台州妇女儿童医院全科医学科,浙江台州317700

出　　处：《温州医科大学学报》2023年第10期775-781,共7页Journal of Wenzhou Medical University

基　　金：国家自然科学基金项目(82100074);温州市基础性科研项目(Y20210712)。

摘　　要：目的:探讨宿主免疫反应标志物在预测感染患者进展为脓毒症的风险及预后判断中的价值,为防治脓毒症提供参考依据。方法:收集温州医科大学附属第二医院2019年1月至2021年12月因感染性疾病在急诊留观并住院治疗的成人患者。收集感染患者人口学资料、基础合并症、英国国家早期预警(NEWS)评分、宿主免疫反应标志物等资料。根据感染患者是否进展为脓毒症分为脓毒症组和感染组。采用单因素及多因素Logistic回归分析筛选具有独立预测感染进展为脓毒症的宿主免疫反应标志物,并采用ROC曲线下面积(AUC)、灵敏度、特异度、阳性预测值和阴性预测值对标志物预测性能进行评估。结果:最终纳入294例感染患者,其中138例(46.9%)进展为脓毒症,院内死亡32例(10.9%)。CD3、CD4、C3、CD19、IL-6、IL-10和IgE是感染进展脓毒症的预测因素(OR=0.971、0.965、0.973、1.068、1.028、1.569,均P<0.05)。其中,IL-10预测感染进展为脓毒症的能力最佳,AUC为0.803(0.753~0.854),联合NEWS评分后,AUC达0.844(0.797~0.890);IL-6预测院内死亡的能力最佳,AUC为0.799(0.714~0.884)。结论:宿主免疫反应标志物在感染早期即发生失调,其中IL-6和IL-10预测感染进展为脓毒症和预后的能力最佳,IL-10联合NEWS评分能进一步提升早期脓毒症风险识别能力。Objective:To explore the value of host immune response markers in predicting the risk and prognosis of sepsis in patients with infection,and provide reference for the prevention and treatment of sepsis.Methods:From January 2019 to December 2021,adult patients who visited and were hospitalized due to infectious diseases were collected in the Second Affiliated Hospital of Wenzhou Medical University.The demographic data,comorbidities,national early warning score(NEWS),host immune response markers and other data of infected patients were collected.According to whether the infected patients progressed to sepsis,they were divided into infection group and sepsis group.Univariate and multivariate Logistic regression analysis were used to screen host immune response markers that independently predict the progression of infection to sepsis,and the area under the ROC curve(area under curve,AUC),sensitivity,specificity,positive predictive value and negative prediction value to evaluate the predictive performance of markers.Results:A total of 294 infected patients were finally included,among which 138(46.9%)developed sepsis and 32 died in hospital(10.9%).CD3,CD4,C3,CD19,IL-6,IL-10 and IgE were predictive factors for infection progression to sepsis(OR=0.971,0.965,0.973,1.068,1.028,1.569,P<0.05).Among them,IL-10 had the best ability to predict the progression of infection to sepsis,with an AUC of 0.803(0.753-0.854).After combined with the NEWS,the AUC reached 0.844(0.797-0.890).IL-6 had the best ability to predict in-hospital death,with an AUC is 0.799(0.714-0.884).Conclusion:The host immune response markers are dysregulated in the early stage of infection,among which IL-6 and IL-10 have the best ability to predict the progression of infection to sepsis and prognosis,IL-10 combined with NEWS can further improve early sepsis risk identification,which provides reference for sepsis blocking.

关 键 词：感染 脓毒症 宿主免疫反应标志物 预测 

分 类 号：R544.1[医药卫生—心血管疾病]