细胞因子对血流感染的早期预测价值研究  

The Early Predictive Value of Cytokines in Bloodstream Infections

作　　者：仝凯 聂玉茹 高远[1] 王琦[1] 马静[1] 赵秀英[1] 董静肖 TONG Kai;NIE Yuru;GAO Yuan;WANG Qi;MA Jing;ZHAO Xiuying;DONG Jingxiao(Department of Laboratory Medicine,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院(清华大学临床医学院)检验医学科,北京102218

出　　处：《标记免疫分析与临床》2024年第9期1608-1612,1629,共6页Labeled Immunoassays and Clinical Medicine

基　　金：吴阶平医学基金会危急重症评估决策血液标记物示踪研究项目(编号:2022-26-2)。

摘　　要：目的探讨细胞因子12项对临床血流感染的早期应用价值。方法收集北京清华长庚医院从2023年5月至2024年1月所有血培养阳性的患者标本,通过基质辅助激光解吸电离的飞行时间质谱技术(matrix-assisted laser desorption/ionization time of flight mass spectrometry,MALDI-TOF MS)或细菌鉴定卡鉴别血流感染细菌菌种,通过纳入和排除标准进行筛选后,包括革兰氏阴性细菌(Gram-negative,G-)感染患者55例,革兰氏阳性细菌(Gram-positive,G+)感染患者46例。通过贝克曼流式细胞微球阵列法(cytometry bead array,CBA)检测G-与G+两组患者血流感染同期血浆中细胞因子12项水平,筛选出鉴别G-与G+细菌有显著性差异的细胞因子,并通过ROC曲线比较不同细胞因子及组合鉴别G-菌与G+菌的诊断效能,获取最佳临界值及其灵敏度和特异性。结果G-菌感染组IL-6、IL-8、IL-10、IL-17、TNF-α、IFN-α血浆水平显著高于G+菌感染组(P<0.05)。作6种细胞因子受试者工作曲线(receiver operator characteristic curve,ROC),IL-6鉴别G-/G+菌的ROC曲线下面积(area under curve,AUC)为0.796,最佳cut-off值为115.29pg/mL,诊断灵敏度为72.7%,特异性为82.6%;IL-8鉴别G-/G+菌的AUC为0.670,最佳cut-off值为55.75pg/mL,诊断灵敏度为85.5%,特异性为50.0%;IL-10鉴别G-/G+菌的AUC为0.715,最佳cut-off值33.62pg/mL,诊断灵敏度为52.7%,特异性为84.8%;IL-17鉴别G-/G+菌的AUC为0.561,最佳cut-off值2.41pg/mL,诊断灵敏度为70.9%,特异性为67.0%;TNF-α鉴别G-/G+菌的AUC为0.716,最佳cut-off值1.75pg/mL,诊断灵敏度为49.1%,特异性为78.3%;IFN-α鉴别G-/G+菌的AUC为0.641,cut-off值1.79pg/mL,诊断灵敏度为58.2%,特异性为83.6%;IL-6、IL-8、IL-10、IL-17、TNF-α、IFN-α6项联合鉴别G-与G+菌感染的AUC为0.817,灵敏度为63.6%,特异性为89.1%,诊断效能优于单个细胞因子。结论细胞因子联合模型辅助临床早期鉴别G-/G+菌血流感染,为临床早期抗生素选择提供依据。Objective To explore the early application value of 12 cytokines in bacterial bloodstream infections(BSI).Methods We collected specimens from all blood culture-positive patients at Beijing Tsinghua Changgung Hospital from May,2023 to January,2024 for the current study.Matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF MS)technique and VITEK 2 bacterial identification card were used to identify the bacterial species causing bloodstream infections.After screening process based on defined inclusion and exclusion criteria,a total of 55 patients with Gram-negative bacteria(GN-BSI)and 46 patients with Gram-positive bacteria(GP-BSI)were enrolled for the study.The concentrations of 12 cytokines in the plasma of patients with GN-BSI and GP-BSI were detected using cytometry bead array(CBA)method of Beckman Cytokines that showed significant variations in identifying G-and G+bacteria selected.The diagnostic efficacy of different cytokines and combinations in identifying G-and G+bacteria was evaluate and compared using receiver operating characteristic(ROC)curves by obtaining the optimal cut-off values,sensitivity,and specificity.Results Plasma concentrations of IL-6,IL-8,IL-10,IL-17,TNF-α,and IFN-αwere significantly up-regulated in GN-BSI(P<0.05).The area under the curve(AUC)of IL-6 was 0.796,with an optimal cut-off value of 115.29 pg/mL,sensitivity of 72.7%,and specificity of 82.6%.AUC of IL-8 was 0.670,with an optimal cut-off value of 55.75pg/mL,sensitivity of 85.5%,and specificity of 50.0%.AUC 0f IL-10 was 0.715,with an optimal cut-off value of 33.62 pg/mL,sensitivity of 52.7%,and specificity of 84.8%.AUC of IL-17 was 0.561,with an optimal cut-off value of 2.41 pg/mL,sensitivity of 70.9%,and specificity of 67.0%.AUC of TNF-αwas 0.716,with an optimal cut-off value of 1.75 pg/mL,sensitivity of 49.1%,and specificity of 78.3%.AUC of IFN-αwas 0.641,with an optimal cut-off value of 1.79pg/mL,sensitivity of 58.2%,and specificity of 83.6%.AUC of the combined detection of IL-6,IL-8,IL-10,IL-

关 键 词：细胞因子12项 细菌血流感染 流式微球阵列 抗生素 

分 类 号：R446.5[医药卫生—诊断学]