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IL-27在脓毒症的早期诊断、病情严重程度的判断和预测预后中的作用

发布时间:2018-03-27 16:39

  本文选题:白介素-27 切入点:降钙素原 出处:《江苏大学》2016年硕士论文


【摘要】:目的:探讨白介素27(Interleukin 27,IL-27)在早期诊断成人脓毒症及判断病情严重程度和预后上的价值。方法:研究对象为2014年7月至2015年6月期间入住江苏大学附属宜兴市人民医院ICU(重症监护室)的全身炎症反应综合征(SIRS)患者,年龄在18-70岁之间,诊断符合2001年制定的国际脓毒症定义指南的诊断标准。入住当天即进行常规的感染筛查,经血、痰培养和(或)X线片有感染证据的即纳入脓毒症组,其余的则归为SIRS组。脓毒症组按照诊断标准再分为脓毒症、严重脓毒症、脓毒性休克。在患者入住后的第1,3,7天分别采集5ml血液样本,经离心后取上清液置入EP管后于-40oC冰箱冻藏,待标本收集完毕后,一起取出采用酶联免疫吸附法(ELISA)测定其血清中IL-27浓度,酶联荧光法(ELFA)测定降钙素原(PCT)浓度,免疫比浊法测定C反应蛋白(CRP)浓度。除此之外,我们会收集患者的基本情况,包括年龄,性别,体温,白细胞计数,APACHE-Ⅱ评分等,并在28天后随访观察患者预后。采用t检验比较两组间的第1,3,7天的IL-27、PCT、CRP的浓度差异,单因素方差分析法比较两组内的1,3,7天的IL-27、PCT、CRP的变化情况和脓毒症、严重脓毒症、脓毒性休克三组之间的各指标浓度差异。绘制受试者操作特征曲线(ROC)来评估各指标的诊断价值。采用Pearson相关系数分析各指标与APCACHEⅡ的关系。采用Cox回归法分析各指标与预后的关系。结果:共有118名患者参与研究,其中脓毒症75例,SIRS43例。脓毒症组中,有53例脓毒症、14例严重脓毒症和8例浓度增休克。28天后共有37例患者死亡。脓毒症组在第一天的IL-27、PCT浓度分别为3.19±1.11ng/ml和2.22±1.06ng/ml显著高于SIRS组的2.43±0.76ng/ml和1.22±0.69ng/ml(P0.01),CRP在两组之间差异不明显(P0.05)。脓毒症组的IL-27、PCT水平随着治疗进展呈显著下降趋势(P0.05),CRP则变化不明显(P0.05),而SIRS组各指标下降不明显(P0.05)。IL-27的ROC曲线下面积(AUC)为0.745,敏感性和特异性分别为66%和72%,PCT的AUC为0.836,敏感性和特异性分别为75%和86%。CRP的AUC为0.589,敏感性和特异性分别为53%和66%。在脓毒症组中,IL-27、PCT与APACHEⅡ均有较好的相关性,R2分别为0.6585和0.8265。IL-27、PCT与患者预后相关,预测死亡的准确率分别达到了68%和76.4%。结论:IL-27是一种早期诊断脓毒症的有效指标,对判断脓毒症的严重程度和预后也有一定帮助,但其各项效价与PCT比还存在差距。将来需要更多大样本量的随机对照实验来研究IL-27在脓毒症诊疗方面的价值。
[Abstract]:Objective: to investigate the value of interleukin 27(Interleukin 27 (IL 27) in the early diagnosis of adult sepsis and in judging the severity and prognosis of the disease. Methods: the subjects were admitted to the people's Medicine of Yixing City affiliated to Jiangsu University from July 2014 to June 2015. Hospital ICU (intensive Care Unit) patients with systemic inflammatory response syndrome (SIRS), Between the ages of 18 and 70, the diagnosis meets the diagnostic criteria of the international guidelines for the definition of sepsis established in 2001. Routine infection screening is carried out on the day of admission, and blood, sputum culture and / or X-ray evidence of infection are included in the sepsis group. The rest were classified into SIRS group. Sepsis group was subdivided into sepsis, severe sepsis, septic shock according to diagnostic criteria. Blood samples of 5ml were collected on the 1st day after admission. After centrifugation, the supernatant was placed into EP tube and frozen in -40oC refrigerator. After collecting the samples, the serum IL-27 concentration was determined by Elisa, and the concentration of procalcitonin was determined by enzyme-linked fluorescence assay (ELFAA). In addition, we collect the basic information of the patients, including age, sex, body temperature, white blood cell count and Apache 鈪,

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