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目的通过观察脓毒症病人血清白细胞介素-35(IL-35)的变化规律,探讨其与感染的关系及对疾病预后的影响。方法采用前瞻性研究方法,选择67例脓毒症病人为脓毒症组;同时选择符合全身炎性反应综合征(SIRS)但无感染病人(30例)以及健康志愿者(30例)作为对照。于病人入重症医学科(ICU)3 h内取血,采用酶联免疫吸附试验(ELISA)检测IL-35、降钙素原(PCT),并计算急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,根据病人入院后28 d生存结局,比较存活组(57例)与死亡组(40例)病人之间IL-35水平的差异。采用多种非参数方法分析脓毒症病人IL-35与上述指标的相关性;获得IL-35诊断脓毒症及预后判断的价值。结果脓毒症病人血清IL-35较SIRS组及健康对照组明显升高[0.43(0.25)比0.24(0.09)、0.15(0.00)ng·L~(-1),Z=7.862,P<0.01],PCT较SIRS组明显升高[6.92(23.44)比2.09(1.53)μg·L~(-1),Z=-2.038,P<0.05],健康组、SIRS组,脓毒症组的APACHEⅡ评分、PCT、IL-35水平随疾病严重程度加深而升高,且脓毒症组IL-35与APACHEⅡ评分(r=0.587,P<0.001)、PCT(r=0.691,P<0.001)均呈显著正相关,此外,ROC分析知:以IL-35=0.30 ng·L~(-1)为阈值,其预测死亡预后的灵敏度=0.722,特异性=0.759,曲线下面积AUC=0.735,提示IL-35对脓毒症预后预测价值较好。结论脓毒症病人血清IL-35较SIRS组及健康对照组明显上升,且与PCT水平呈正相关,对感染有诊断意义;血清IL-35与APACHEⅡ评分呈正相关,故其水平随APACHEⅡ评分升高而升高,而且死亡组IL-35水平较存活组明显升高,IL-35水平的高低对脓毒症病人的预后有重要提示意义。
Objective To observe the change of serum interleukin-35 (IL-35) in patients with sepsis and explore its relationship with infection and prognosis. Methods Sixty-seven sepsis patients were selected as the sepsis group by prospective study. In the meantime, 30 patients with systemic inflammatory response syndrome (SIRS) but no infection (n = 30) and 30 healthy volunteers (n = 30) . The patients were admitted to the intensive care unit (ICU) within 3 h. IL-35 and procalcitonin (PCT) were detected by enzyme linked immunosorbent assay (ELISA), and the scores of acute physiology and chronic health evaluation system Ⅱ ) Score. The difference in IL-35 level between survivors (57 patients) and death patients (40 patients) was compared according to the patient’s 28-day survival after admission. Using a variety of non-parametric methods analysis of sepsis patients IL-35 and the above indicators of relevance; IL-35 diagnosis of sepsis and prognosis of the value. Results Serum IL-35 levels in patients with sepsis were significantly higher than those in SIRS and healthy controls [0.43 (0.25) vs 0.24 (0.09), 0.15 (0.00) ng · L -1, Z = 7.862, P 0.01 (P <0.05). Compared with SIRS group, PCT was significantly increased in the healthy group, SIRS group and sepsis group [6.92 (23.44) vs 2.09 (1.53) μg · L -1, Z = -2.038, The levels of IL-35 and APACHEⅡ in sepsis group (r = 0.587, P <0.001), PCT (r = 0.691, P <0.001) were significantly higher than those in sepsis group ROC analysis showed that the sensitivity to predict the prognosis of death was 0.722 and the specificity was 0.759 with the IL-35 value of 0.30 ng · L -1 as the threshold. The area under the curve AUC was 0.735, suggesting that IL -35 Predict the prognosis of sepsis is better. Conclusions Serum IL-35 in patients with sepsis was significantly higher than that in SIRS and healthy controls, and it was positively correlated with PCT level and had a diagnostic significance for infection. Serum IL-35 was positively correlated with APACHEⅡ score, so its level increased with APACHEⅡ score But the level of IL-35 in the death group was significantly higher than that in the survival group. The level of IL-35 was of great significance to the prognosis of patients with sepsis.