脓毒症急性肺损伤患者外周血IFN-γ/IL-4、Th1/Th2水平与疾病预后的关系  

Relationship between IFN-γ/IL-4 and Th1/Th2 levels in peripheral blood and prognosis of patients with acute lung injury caused by sepsis

作　　者：陈谦 蒋文强 王才宏 杨雍 CHEN Qian;JIANG Wenqiang;WANG Caihong;YANG Yong(Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology of China,Mianyang Central Hospital,Mianyang 621000,Sichuan,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院,四川绵阳621000

出　　处：《西部医学》2024年第11期1659-1665,共7页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会项目(16PJ187)。

摘　　要：目的探讨脓毒症急性肺损伤(ALI)患者外周血γ干扰素(IFN-γ)/白细胞介素-4(IL-4)、辅助性T淋巴细胞(Th)1/Th2水平与疾病预后的关系。方法选取2020年1月—2023年1月我院收治的脓毒症ALI患者104例作为观察组,单纯脓毒症患者104例作为对照Ⅰ组,同期体检健康者104例作为对照Ⅱ组。对比3组外周血IFN-γ/IL-4、Th1/Th2水平。观察组根据治疗28 d疾病预后分为生存组(n=74)与病死组(n=30),分析脓毒症ALI患者外周血IFN-γ/IL-4、Th1/Th2水平与C反应蛋白、急性生理与慢性健康状况系统Ⅱ(APACHEⅡ)评分间相关性,单因素及多因素Logistic回归分析28 d生存情况的影响因素,限制性立方样条图分析外周血IFN-γ/IL-4、Th1/Th2水平与28 d生存情况的剂量-效应关系,受试者工作特征曲线(ROC曲线)分析外周血IFN-γ/IL-4、Th1/Th2水平对疾病预后的评估价值。结果观察组外周血IFN-γ、Th1、IFN-γ/IL-4、Th1/Th2水平低于对照Ⅰ组、对照Ⅱ组,IL-4、Th2水平高于对照Ⅰ组、对照Ⅱ组(P<0.05),对照Ⅰ组外周血IFN-γ、Th1、IFN-γ/IL-4、Th1/Th2低于对照Ⅱ组,IL-4、Th2水平高于对照Ⅱ组(P<0.05);观察组28 d后病死率28.85%,病死组外周血IFN-γ、Th1、IFN-γ/IL-4、Th1/Th2水平低于生存组,IL-4、Th2水平高于生存组(P<0.05);病死组吸烟比率、APACHEⅡ评分、动脉血乳酸、C反应蛋白、降钙素原水平高于生存组,氧合指数低于生存组(P<0.05);外周血IFN-γ/IL-4、Th1/Th2水平与APACHEⅡ评分呈高度负相关(r=0.844,0.878,均P<0.001),外周血IFN-γ/IL-4、Th1/Th2水平与C反应蛋白呈中度负相关(r=0.778,0.763,均P<0.001);动脉血乳酸、降钙素原是脓毒症ALI患者28 d生存情况的独立危险因素,氧合指数、IFN-γ/IL-4、Th1/Th2是脓毒症ALI患者28 d生存情况的独立保护因素(P<0.05);当外周血IFN-γ/IL-4水平<2.5、Th1/Th2水平<0.43时,脓毒症ALI患者28 d病死风险显著增加,外周血IFN-γ/IL-4、Th1/Th2水平联合评估脓毒症ALI�Objective To investigate the relationship between the levels of interferonγ(IFN-γ)/interleukin-4(IL-4)and helper T lymphocytes(Th)1/Th2 in peripheral blood and the prognosis of patients with acute lung injury(ALI)with sepsis.Methods A total of 104 patients with sepsis ALI in our hospital from January 2020 to January 2023 were selected as the study group,104 patients with simple sepsis during the same period were selected as control groupⅠ,and 104 healthy subjects were selected as control groupⅡ.The levels of IFN-γ/IL-4 and Th1/Th2 in peripheral blood of the three groups were compared.The study group was divided into survival patients and death patients according to the prognosis of disease after 28 days of treatment.Analysis of peripheral blood IFN in ALI patients with sepsis-γ/The correlation between IL-4,Th1/Th2 levels and C-reactive protein,APACHEⅡscores.Univariate and multivariate Logistic regression analysis were conducted to analyze the influencing factors of 28-day survival.The dose-effect relationship between peripheral blood IFN-γ/IL-4 and Th1/Th2 levels and survival at 28 d was analyzed by restricted cubic spines.The value of peripheral blood IFN-γ/IL-4 and Th1/Th2 levels in prognosis was analyzed by receiver operating characteristic curve(ROC curve).Results The levels of peripheral blood IFN-γ,Th1,IFN-γ/IL-4 and Th1/Th2 in study group were lower than those in control groupⅠand control groupⅡ,and the levels of IL-4 and Th2 in control groupⅠwere higher than those in control groupⅠand control groupⅡ(P<0.05),and the levels of peripheral blood IFN-γ,Th1,IFN-γ/IL-4 and Th1/Th2 in control groupⅠwere lower than those in control groupⅡ,while the levels of IL-4 and Th2 were higher than those of control groupⅡ(P<0.05).In the study group,the case fatality rate after 28 days was 28.85%(30/104).The levels of IFN-γ,Th1,IFN-γ/IL-4 and Th1/Th2 in peripheral blood of patients who died were lower than those of patients who survived,while the levels of IL-4 and Th2 were higher than those

关 键 词：脓毒症 急性肺损伤 γ干扰素 白细胞介素-4 TH1/TH2 疾病预后 

分 类 号：R631[医药卫生—外科学]