本文選題：白介素-27　切入點(diǎn)：降鈣素原　出處：《江蘇大學(xué)》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(yán)重程度和預(yù)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(xué)附屬宜興市人民醫(yī)院ICU(重癥監(jiān)護(hù)室)的全身炎癥反應(yīng)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(biāo)準(zhǔn)。入住當(dāng)天即進(jìn)行常規(guī)的感染篩查,經(jīng)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(biāo)準(zhǔn)再分為膿毒癥、嚴(yán)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(jīng)離心后取上清液置入EP管后于-40oC冰箱凍藏,待標(biāo)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(yīng)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(xì)胞計數(shù),APACHE-Ⅱ評分等,并在28天后隨訪觀察患者預(yù)后。采用t檢驗(yàn)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(nèi)的1,3,7天的IL-27、PCT、CRP的變化情況和膿毒癥、嚴(yán)重膿毒癥、膿毒性休克三組之間的各指標(biāo)濃度差異。繪制受試者操作特征曲線(ROC)來評估各指標(biāo)的診斷價值。采用Pearson相關(guān)系數(shù)分析各指標(biāo)與APCACHEⅡ的關(guān)系。采用Cox回歸法分析各指標(biāo)與預(yù)后的關(guān)系。結(jié)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(yán)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(jìn)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(biāo)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(guān)性,R2分別為0.6585和0.8265。IL-27、PCT與患者預(yù)后相關(guān),預(yù)測死亡的準(zhǔn)確率分別達(dá)到了68%和76.4%。結(jié)論:IL-27是一種早期診斷膿毒癥的有效指標(biāo),對判斷膿毒癥的嚴(yán)重程度和預(yù)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(jī)對照實(shí)驗(yàn)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