白细胞介素-6与可溶性肿瘤抑制因子2对腹腔感染脓毒症患者合并急性呼吸窘迫综合征的诊断意义  

Predictive value of interleukin-6 combined with soluble suppression of tumorigenicity 2 for acute respiratory distress syndrome inpatients with abdominal sepsis

作　　者：赵玉月 钱瑞 李涛[1] 段军[1] Zhao Yuyue;Qian Rui;Li Tao;Duan Jun(Department of Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院重症医学科,北京100029

出　　处：《中国中西医结合急救杂志》2024年第5期533-537,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：北京市重大疫情重点专科防控项目(2022-ZX-007)。

摘　　要：目的探讨血浆白细胞介素-6(IL-6)和可溶性肿瘤抑制因子2(sST2)对腹腔感染脓毒症患者合并急性呼吸窘迫综合征(ARDS)的预测和诊断价值。方法采用回顾性研究方法,收集2022年1月至2023年12月入住中日友好医院重症医学科腹腔感染脓毒症患者的临床资料,包括性别、年龄、sST2、IL-6、降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞比例、血红蛋白(Hb)、血小板计数(PLT)乳酸脱氢酶(LDH)pH值、动脉血氧分压(PaO_(2))、吸入氧浓度(FiO_(2))动脉血二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))血乳酸(Lac)、凝血酶原时间(PT)活化部分凝血活酶时间(APTT)、D-二聚体、急性生理学与慢性健康状况评分I(APACHEI)评分、序贯器官衰竭评分(SOFA)评分。将患者按是否发生ARDS分为两组,比较是否发生ARDS两组患者上述指标的差异。采用Spearman相关性分析法分析脓毒症ARDS组患者血浆IL-6及sST2水平与临床指标的相关性;采用多元Logistic回归分析腹腔感染脓毒症患者发生ARDS的危险因素,并绘制受试者工作特征曲线(ROC曲线)评估IL-6和ST2对脓毒症患者发生ARDS的预测价值。结果最终纳入89例因腹腔感染导致脓毒症的患者,发生ARDS组41例,未发生ARDS组48例。与未发生ARDS组比较,发生ARDS组sST2、IL-6、PaCO_(2)、APACHEⅡ评分、SOFA评分、FiO_(2)均明显升高[sST2(μg/L):733.7(370.1,1609.1)比86.1(64.1,129.1),IL-6(ng/L):1106.79(405.37,3848.00)比101.00(44.00,396.00),PaCO_(2)(mmHg 1mmHg~0.133kPa):40.00(35.50,45.50)比36.00(31.85,40.73),APACHEI评分(分):31.7±1.0比28.6±0.9,S0FA评分(分):10.30±0.50比8.17±0.70,FiO_(2):0.600(0.500,1.000)比0.400(0.400,0.575),均P<0.05],APTT明显延长[s:49.70(41.95,56.43)比43.30(39.40,49.60)],pH值、PaO_(2)、PaO_(2)/FiO_(2)均明显降低[pH值:7.37(7.30,7.43)比7.41(7.35,7.47),PaO_(2)(mmHg):82.00(68.00,107.00)比119.50(101.25,154.00),Pa0,/FiO_(2)(mmHg):157.00(99.10,200.00)比297.56(228.00,386.00Objective To evaluate the predictive and diagnostic value of plasma interleukin-6(IL-6)and soluble suppression of tumorigenicity 2(sST2)for acute respiratory distress syndrome(ARDS)in patients with abdominal sepsis.Methods A retrospective study method was adopted,clinical data from patients with abdominal sepsis admitted to the department of critical care medicine of China-Japan Friendship Hospital,between January 2022 and Decemher 2023 were collected.These data included gender,age,sST2,IL-6,procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC),neutrophil ratio,hemoglobin(Hb),platelet count(PLT),lactate dehydrogenase(LDH),pH value,arterial partial pressure of oxygen(PaO_(2)),fraction of inspired oxygen(FiO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),arterial blood lactate acid(Lac),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,acute physiology and chronic health evaluation II(APACHE II)score,and sequential organ failure assessment(SOFA)score.Patients were divided into two groups based on the presence or absence of ARDS.The differences in the above indices between the two groups were analyzed.Spearman correlation analysis was used to examine the relationship between plasma IL-6 and sST2 levels and clinical indicators in the ARDS group.Multivariate Logistic regression was conducted to identify risk factors for ARDS in patients with abdominal sepsis,and receiver operator characteristic curve(ROC curve)were used to assess the predictive value of IL-6 and sST2 for ARDS.Results A total of 89 patients with abdominal sepsis were included,with 41 in the ARDS group and 48 in the non-ARDS group.Compared with the non-ARDS group,the ARDS group showed significantly higher levels of sST2,IL-6.PaCO_(2),APACHE II score,SOFA score,and FiO_(2)[sST2(μg/L):733.7(370.1,1609.1)vs.86.1(64.1,129.1),IL-6(ng/L):1106.79(405.37,3848.00)vs.101.00(44.00,396.00),PaC02(mmHg.1 mmHg~0.133 kPa):40.00(35.50,45.50)vs.36.00(31.85,40.73),APACHE II score:31.7�

关 键 词：脓毒症 急性呼吸窘迫综合征 肿瘤抑制因子2 白细胞介素-6 

分 类 号：R54[医药卫生—心血管疾病]