重症肺炎患者外周血Th1/Th2细胞因子水平变化及其临床意义  

Changes in Th1/Th2 cytokine levels in peripheral blood of patients with severe pneumonia and the clinical significance

作　　者：张友文 王晨 韩亮[3] 陈志 山凤莲[1] Zhang Youwen;Wang Chen;Han Liang;Chen Zhi;Shan Fenglian(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272013,China;Department of Blood Purification,Affiliated Hospital of Jining Medical University,Jining 272013,China;Department of Clinical Laboratory,Affiliated Hospital of Jining Medical University,Jining 272013,China)

机构地区：[1]济宁医学院附属医院呼吸与危重症医学科,济宁272013 [2]济宁医学院附属医院血液净化科,济宁272013 [3]济宁医学院附属医院检验科,济宁272013

出　　处：《国际呼吸杂志》2025年第2期153-157,共5页International Journal of Respiration

基　　金：济宁市重点研发计划项目(2024YXNS116)。

摘　　要：目的探讨重症肺炎患者外周血Th1/Th2细胞因子水平变化及其临床意义。方法本研究为病例对照研究。采用非随机抽样方法,选取2022年2月至2023年12月济宁医学院附属医院收治的118例重症肺炎患者为研究对象。依据重症肺炎患者入住呼吸与危重症医学科或重症监护室后28 d的生存情况,分为生存组(85例,72.03%)和死亡组(33例,27.97%)。比较2组患者临床资料、外周血Th1/Th2细胞因子水平[包括γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)]。多因素logistic回归分析影响重症肺炎患者预后的因素。采用受试者操作特征曲线分析IFN-γ、TNF-α、IL-10和三者联合对重症肺炎患者预后的预测价值。结果生存组男44例(51.76%),女41例(48.24%),年龄(57.41±9.24)岁;死亡组男18例(54.55%),女15例(45.45%),年龄(56.82±8.75)岁。2组患者性别、年龄差异均无统计学意义(χ^(2)=0.07,P=0.786;t=0.32,P=0.753)。死亡组IFN-γ、TNF-α和IL-10水平高于生存组[(25.08±3.75)ng/L比(18.13±2.46)ng/L,t=11.79,P<0.001;(52.78±7.04)ng/L比(38.15±5.42)ng/L,t=12.07,P<0.001;(18.42±3.76)ng/L比(13.58±2.91)ng/L,t=7.45,P<0.001]。多因素logistic回归分析结果显示,高IFN-γ(OR=3.155,95%CI:1.362~7.308)、高TNF-α(OR=3.438,95%CI:1.484~7.964)和高IL-10(OR=2.954,95%CI:1.275~6.841)均为重症肺炎患者死亡的危险因素(均P<0.001)。受试者操作特征曲线分析结果显示,血清IFN-γ、TNF-α、IL-10和三者联合对重症肺炎患者预后进行预测的曲线下面积分别为0.818(95%CI:0.737~0.883)、0.826(95%CI:0.746~0.890)、0.850(95%CI:0.772~0.909)、0.911(95%CI:0.844~0.955)。结论外周血Th1/Th2细胞因子IFN-γ、TNF-α、IL-10水平在死亡重症肺炎患者中异常偏高,可作为预测重症肺炎患者预后的重要标志物。ObjectiveTo investigate the changes in T helper 1(Th1)/Th2 cytokine levels in peripheral blood of patients with severe pneumonia and the clinical significance.MethodsThis was a case-control study.A total of 118 patients with severe pneumonia admitted to the Affiliated Hospital of Jining Medical University from February 2022 to December 2023 were selected by non-random sampling.The survival status of severe pneumonia patients after 28 days in respiratory and critical care department and intensive care unit was recorded,and the patients were divided into survival group(85 cases,72.03%)and death group(33 cases,27.97%).The clinical data and Th1/Th2 cytokine levels in peripheral blood(interferonγ[IFN-γ],tumor necrosis factorα[TNF-α]and interleukin-10[IL-10])were compared between groups.Multivariate logistic regression analysis was used to analyze the factors affecting the prognosis of severe pneumonia.The predictive value of serum IFN-γ,TNF-α,IL-10 and their combination on the prognosis of severe pneumonia patients was analyzed by receiver operating characteristic(ROC)curve.ResultsThere were 44(51.76%)males and 41(48.24%)females in the survival group,with an average age of 57.41±9.24 years.There were 18(54.55%)males and 15(45.45%)females in the death group,with an average age of 56.82±8.75 years.There were no significant differences in the gender and age between the two groups(χ^(2)=0.07,P=0.786;t=0.32,P=0.753).Serum IFN-γ,TNF-αand IL-10 in the death group were significantly higher than the survival group(25.08±3.75 ng/L vs 18.13±2.46 ng/L,t=11.79,P<0.001;52.78±7.04 ng/L vs 38.15±5.42 ng/L,t=12.07,P<0.001;18.42±3.76 ng/L vs 13.58±2.91 ng/L,t=7.45,P<0.001).Multivariate logistic regression analysis showed that high IFN-γ(OR=3.155,95%CI:1.362-7.308),high TNF-α(OR=3.438,95%CI:1.484-7.964)and high IL-10(OR=2.954,95%CI:1.275-6.841)were all risk factors for the mortality in severe pneumonia patients(all P<0.001).The ROC curve showed that the area under the curve(AUC)of serum IFN-γ,TNF-α,IL-10,and their c

关 键 词：肺炎 重症 Γ干扰素 肿瘤坏死因子Α 白细胞介素10 预后 

分 类 号：R47[医药卫生—护理学]