脓毒血症患儿血清IL-1β、IFN-γ、IL-4水平变化及其对革兰阳性菌/革兰阴性菌感染的鉴别诊断价值  

Changes in serum IL-1β,IFN-γand IL-4 levels in children with sepsis and their values in differential diagnosis of Gram-positive/Gram-negative bacterial infection

作　　者：王彦波 刘枭 张明明 李丽[1] 孙中怡 周彬[1] 赵亮 Wang Yanbo;Liu Xiao;Zhang Mingming;Li Li;Sun Zhongyi;Zhou Bin;Zhao Liang(Department of Pediatrics,Xuzhou Central Hospital,Xuzhou 221000,China;The First Clinical Medical College,Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州市中心医院儿科,徐州221000 [2]徐州医科大学第一临床医学院,徐州221000

出　　处：《中华微生物学和免疫学杂志》2023年第12期939-944,共6页Chinese Journal of Microbiology and Immunology

摘　　要：目的观察脓毒血症患儿血清白细胞介素-1β(IL-1β)、干扰素-γ(IFN-γ)、IL-4水平变化,并分析其对革兰阳性(G+)菌/革兰阴性(G-)菌感染的鉴别诊断价值。方法回顾性分析徐州市中心医院2020年2月—2023年2月收治的195例脓毒血症患儿的临床资料,经病原菌培养和鉴定均证实为G+/G-菌感染,为疾病组;另取同时间段医院体检中心接收的健康儿童共180例的剩余血样,为对照组。疾病组采用病原菌培养比较G+/G-菌感染分布情况;2组均采用ELISA检测血清IL-1β、IFN-γ、IL-4水平并比较;根据疾病组G+/G-菌感染情况分为阳性组和阴性组,比较2组血清IL-1β、IFN-γ、IL-4水平;绘制受试者工作特征(ROC)曲线,评价血清IL-1β、IFN-γ、IL-4水平单独及联合对疾病组G+/G-菌感染的鉴别诊断价值。结果疾病组195例患儿血培养标本共分离菌株211株,其中,G+菌感染181株(85.78%),G-菌感染30株(14.22%),G+菌感染中凝固酶阴性葡萄球菌占比最高,G-菌感染中沙门菌占比最高;疾病组血清IL-1β和IFN-γ水平均高于对照组(P<0.05),血清IL-4水平与对照组相当(P>0.05);阴性组血清IL-1β、IFN-γ、IL-4水平均高于阳性组(P<0.05);血清IL-1β、IFN-γ、IL-4水平联合对G+/G-菌感染鉴别诊断的敏感度为91.62%,高于单独诊断(P<0.01),ROC曲线下面积(AUC)为0.960,高于单独诊断(P<0.05),特异度与单独诊断差异无统计学意义(P>0.05)。结论脓毒血症患儿血清IL-1β、IFN-γ水平升高,血清IL-4水平基本正常,且G-菌感染患儿血清IL-1β、IFN-γ、IL-4水平更高,三者联合对G+/G-菌感染鉴别诊断的价值高。Objective To analyze the changes in serum IL-1β,IFN-γand IL-4 levels in children with sepsis and analyze their values in the differential diagnosis of Gram-positive(G+)/Gram-negative(G-)bacterial infection.Methods Clinical data of 195 children with sepsis admitted to Xuzhou Central Hospital from February 2020 to February 2023 were retrospectively analyzed.They were all confirmed to have G+/G-bacterial infection based on pathogen culturing and identification and enrolled as disease group.Another 180 healthy children taking physical examination in the same hospital during the same period were recruited as control group.The distribution of G+/G-bacterial infection in the disease group was analyzed after pathogen culturing.ELISA was used to detect serum IL-1β,IFN-γand IL-4 levels in both groups.Differences in the levels of serum IL-1β,IFN-γand IL-4 were compared between the disease group and the control group as well as between the patients with G+/G-bacterial infection.Receiver operating characteristic(ROC)curve was drawn to evaluate the values of serum IL-1β,IFN-γand IL-4 levels used alone or in combination in the differential diagnosis of G+/G-bacterial infection.Results A total of 211 strains were isolated from 195 blood culture samples in the disease group,including 181 strains(85.78%)of G+bacteria and 30 strains(14.22%)of G-bacteria.Coagulase-negative Staphylococcus and Salmonella were the predominant bacteria causing G+/G-bacterial infection,respectively.The levels of serum IL-1βand IFN-γin the disease group were higher than those in the control group(P<0.05),while the levels of serum IL-4 were similar in the two groups(P>0.05).The levels of serum IL-1β,IFN-γand IL-4 in the patients with G-bacterial infection were higher than those in the patients with G+bacterial infection(P<0.05).The sensitivity and the area under the ROC curve of serum IL-1β,IFN-γand IL-4 levels used in combination in the differential diagnosis of G+/G-bacterial infection were respectively 91.62%and 0.960,which were higher tha

关 键 词：脓毒血症 白细胞介素-1β 干扰素-Γ 白细胞介素-4 革兰阳性菌 革兰阴性菌 

分 类 号：R720.597[医药卫生—急诊医学]