Th1/Th2细胞因子谱在不同感染程度病人水平变化及其对脓毒症病人预后的评估价值  

Changes of Th1/Th2 cytokine profiles in patientswith different infection levels and their prognostic value in patients with sepsis

作　　者：石慧[1] 郑岚[1] 姚晓玲[1] 陈睿[1] 杨晓双[1] 郭晓婕 SHI Hui;ZHENG Lan;YAO Xiaoling;CHEN Rui;YANG Xiaoshuang;GUO Xiaojie(Department of Clinical Laboratory,The Third People′s Hospital of Bengbu,Bengbu Anhui 233000,China)

机构地区：[1]安徽省蚌埠市第三人民医院检验科,233000

出　　处：《蚌埠医学院学报》2024年第8期1057-1061,共5页Journal of Bengbu Medical College

基　　金：安徽省蚌埠市科技局创新指导类项目(20220120)。

摘　　要：目的:探讨外周血1型或2型辅助型T淋巴细胞(Th1/Th2)细胞因子谱对不同感染程度病人的临床应用及其对脓毒症病人短期预后的评估价值。方法:选取78例脓毒症病人(脓毒症组),64例局部感染病人(普通感染组)以及42例非感染病人(非感染组),收集3组病人的临床资料,比较入科后各组病人细胞因子浓度,使用Spearman等级相关分析其与感染严重程度的关系;依据随访结果,将脓毒症病人分成存活组(31例)和死亡组(47例),比较2组Th1/Th2细胞因子谱的差异,采用logistic回归分析筛选影响脓毒症病人预后的独立危险因素,对脓毒症病人28 d生存率进行亚组分析,并绘制Kaplan-Meier生存曲线,分析病人28 d累积生存情况。结果:随着感染严重程度的增加,IL-4水平逐渐降低,IL-6、IL-8及IL-10水平逐渐升高;普通感染组和脓毒症组病人IL-5水平低于非感染组(P<0.05~P<0.01)。Spearman等级相关分析显示,IL-4与感染严重程度呈负相关(P<0.01);IL-6、IL-8、IL-10与感染严重程度呈显著正相关(P<0.01)。随访28 d,脓毒症病人死亡率60.26%。死亡组病人IL-5、IL-6、IL-8、IL-10浓度均大于存活组(P<0.05~P<0.01);logistic回归分析显示,IL-5和IL-8是脓毒症病人28 d死亡的独立危险因素(P<0.05);根据最佳截断值对IL-5、IL-8进行亚分组,结果提示IL-5、IL-8升高,增加了脓毒症病人28 d死亡的风险。Kaplan-Meier生存分析进一步证实了IL-5≥0.55 pg/mL组病人的28 d累积生存率明显低于IL-5<0.55 pg/mL组病人(P<0.05);IL-8≥54.61 pg/mL组病人的28 d累积生存率明显低于IL-8<54.61 pg/mL组病人(P<0.01)。结论:Th1/Th2细胞因子谱与感染严重程度呈现出显著的相关关系,且IL-5及IL-8对脓毒症病人28 d生存情况具有良好的预测价值。Objective:To investigate the clinical application of peripheral blood type 1 or type 2 helper T lymphocyte(Th1/Th2)cytokine profiles in patients with different infection degrees,and their evaluation value of short-term prognosis in patients with sepsis.Methods:Seventy-eight patients with sepsis,64 patients with local infection and 42 patients without infection were divided into the sepsis group,common infection group and non-infection group,respectively.The clinical data of three groups were collected,and the cytokine concentrations among three groups were compared after hospitalization,and the Spearman grade correlation was used to predict their relationship with infection severity.According to the follow-up results,the sepsis patients were divided into the survival group(31 cases)and death group(47 cases),and the differences of Th1/Th2 cytokine profiles between two groups were compared.The independent risk factors affecting prognosis of sepsis patients were screened by logistic regression analysis,and the 28 d survival rate of sepsis patients was analyzed in two subgroups.Kaplan-Meier survival curve was drawn to analyze the 28 d cumulative survival of patients.Results:With the increasing of infection severity,the level of IL-4 decreased gradually,while the levels of IL-6,IL-8 and IL-10 increased gradually.The levels of IL-5 in the sepsis group and common infection group were lower than that in non-infection group(P<0.05 to P<0.01).The results of Spearman correlation analysis that showed the IL-4 was significantly negatively correlated with infection severity(P<0.01),and the levels of IL-6,IL-8 and IL-10 were positively correlated with the severity of infection(P<0.01).After 28 d of follow-up,the mortality of sepsis patients was 60.26%.The concentrations of IL-5,IL-6,IL-8 and IL-10 in the death group were higher than those in survival group(P<0.05 to P<0.01).The results of logistic regression analysis showed that the IL-5 and IL-8 were the independent risk factors of 28 d death in sepsis patients(P<0.05).The IL-

关 键 词：感染 脓毒症 T淋巴细胞 细胞因子谱 

分 类 号：R631[医药卫生—外科学] R392.11[医药卫生—临床医学]