本文選題：白介素-27　切入點：降鈣素原　出處：《江蘇大學》2016年碩士論文

【摘要】：目的:探討白介素27(Interleukin 27,IL-27)在早期診斷成人膿毒癥及判斷病情嚴重程度和預后上的價值。方法:研究對象為2014年7月至2015年6月期間入住江蘇大學附屬宜興市人民醫(yī)院ICU(重癥監(jiān)護室)的全身炎癥反應綜合征(SIRS)患者,年齡在18-70歲之間,診斷符合2001年制定的國際膿毒癥定義指南的診斷標準。入住當天即進行常規(guī)的感染篩查,經血、痰培養(yǎng)和(或)X線片有感染證據(jù)的即納入膿毒癥組,其余的則歸為SIRS組。膿毒癥組按照診斷標準再分為膿毒癥、嚴重膿毒癥、膿毒性休克。在患者入住后的第1,3,7天分別采集5ml血液樣本,經離心后取上清液置入EP管后于-40oC冰箱凍藏,待標本收集完畢后,一起取出采用酶聯(lián)免疫吸附法(ELISA)測定其血清中IL-27濃度,酶聯(lián)熒光法(ELFA)測定降鈣素原(PCT)濃度,免疫比濁法測定C反應蛋白(CRP)濃度。除此之外,我們會收集患者的基本情況,包括年齡,性別,體溫,白細胞計數(shù),APACHE-Ⅱ評分等,并在28天后隨訪觀察患者預后。采用t檢驗比較兩組間的第1,3,7天的IL-27、PCT、CRP的濃度差異,單因素方差分析法比較兩組內的1,3,7天的IL-27、PCT、CRP的變化情況和膿毒癥、嚴重膿毒癥、膿毒性休克三組之間的各指標濃度差異。繪制受試者操作特征曲線(ROC)來評估各指標的診斷價值。采用Pearson相關系數(shù)分析各指標與APCACHEⅡ的關系。采用Cox回歸法分析各指標與預后的關系。結果:共有118名患者參與研究,其中膿毒癥75例,SIRS43例。膿毒癥組中,有53例膿毒癥、14例嚴重膿毒癥和8例濃度增休克。28天后共有37例患者死亡。膿毒癥組在第一天的IL-27、PCT濃度分別為3.19±1.11ng/ml和2.22±1.06ng/ml顯著高于SIRS組的2.43±0.76ng/ml和1.22±0.69ng/ml(P0.01),CRP在兩組之間差異不明顯(P0.05)。膿毒癥組的IL-27、PCT水平隨著治療進展呈顯著下降趨勢(P0.05),CRP則變化不明顯(P0.05),而SIRS組各指標下降不明顯(P0.05)。IL-27的ROC曲線下面積(AUC)為0.745,敏感性和特異性分別為66%和72%,PCT的AUC為0.836,敏感性和特異性分別為75%和86%。CRP的AUC為0.589,敏感性和特異性分別為53%和66%。在膿毒癥組中,IL-27、PCT與APACHEⅡ均有較好的相關性,R2分別為0.6585和0.8265。IL-27、PCT與患者預后相關,預測死亡的準確率分別達到了68%和76.4%。結論:IL-27是一種早期診斷膿毒癥的有效指標,對判斷膿毒癥的嚴重程度和預后也有一定幫助,但其各項效價與PCT比還存在差距。將來需要更多大樣本量的隨機對照實驗來研究IL-27在膿毒癥診療方面的價值。
[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，

本文編號：1672340