【摘要】：目的:探討白介素-27(IL-27)在膿毒癥的早期診斷、判斷嚴(yán)重程度及預(yù)測預(yù)后上的價值。方法:納入2014年7月—2015年7月入住江蘇大學(xué)附屬宜興市人民醫(yī)院重癥監(jiān)護(hù)室(ICU)的全身炎癥反應(yīng)綜合征(SRIS)患者,經(jīng)感染篩查(血、痰、尿液培養(yǎng)和X胸片),參照2012年國際膿毒癥定義指南標(biāo)準(zhǔn)診斷為膿毒癥并歸為膿毒癥組,其余歸為SIRS組。根據(jù)診斷標(biāo)準(zhǔn),再將膿毒癥患者分為膿毒癥、嚴(yán)重膿毒癥和膿毒性休克。在第1、3、7天采集血液樣本測定其中IL-27和降鈣素原(PCT)水平,分析兩組間的IL-27和PCT差別,繪制ROC曲線并計算曲線下面積(AUC)來判斷其診斷價值。采用Pearson相關(guān)系數(shù)計算兩指標(biāo)與APACHEⅡ的相關(guān)性來評估其對判斷患者病情嚴(yán)重程度的價值。膿毒癥組隨訪28 d調(diào)查預(yù)后。結(jié)果:共有118例,其中膿毒癥組75例,SRIS組43例。膿毒癥組中包含膿毒癥53例、嚴(yán)重膿毒癥14例,膿毒性休克8例。膿毒癥組第1、3、7天IL-27和PCT水平均明顯高于SIRS組(P0.05),其中第1天升高最明顯。IL-27的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78%和75%。IL-27聯(lián)合PCT檢測的AUC為0.884,敏感性、特異性分別為83%,88%。IL-27和PCT水平在膿毒性休克組明顯高于膿毒癥組和嚴(yán)重膿毒癥組(P0.05),并與APACHEⅡ有著較高的相關(guān)性,R2分別為0.659和0.827。28 d隨訪存活45例,死亡30例,死亡組IL-27和PCT水平明顯高于存活組(P0.05),兩者均為影響膿毒癥患者預(yù)后的獨立危險因素(P0.01)。結(jié)論:IL-27對膿毒癥的早期診斷,嚴(yán)重程度的判斷和預(yù)測預(yù)后均有一定幫助,但與PCT相比存在差距,聯(lián)合檢測IL-27和PCT對早期診斷膿毒癥可以取得更好的效果。
[Abstract]:Objective: to investigate the value of IL-27 (IL-27) in the early diagnosis, severity and prognosis of sepsis. Methods: the patients with systemic inflammatory response syndrome (SRIS) admitted to the intensive care unit of Yixing people's Hospital affiliated to Jiangsu University from July 2014 to July 2015 were screened for infection (blood, sputum, urine culture and X-ray chest radiography). According to the 2012 international definition guidelines of sepsis, they were diagnosed as sepsis group and classified as sepsis group, and the rest were classified as SIRS group. According to the diagnostic criteria, sepsis patients were divided into sepsis, severe sepsis and septic shock. On the 1st and 7th day, the levels of IL-27 and procalcitonin (PCT) were measured. The differences of IL-27 and PCT between the two groups were analyzed. The ROC curve was drawn and the area (AUC) under the curve was calculated to judge its diagnostic value. The correlation between the two indexes and Apache II was calculated by Pearson correlation coefficient to evaluate its value in judging the severity of the patient's condition. The prognosis of sepsis group was investigated after 28 days follow-up. Results: there were 118 cases, including 75 cases in sepsis group and 43 cases in SRIS group. There were 53 cases of sepsis, 14 cases of severe sepsis and 8 cases of septic shock in sepsis group. The levels of IL-27 and PCT in sepsis group were significantly higher than those in SIRS group on the 1st and 7th day (P 0.05). The AUC of IL-27 was 0.745, the sensitivity and specificity were 66% and 72%, the AUC of PCT was 0.836, the sensitivity and specificity were 78%, and the sensitivity and specificity of 75%.IL-27 combined with PCT were 0.884%, 83%, respectively. The levels of 88%.IL-27 and PCT in septic shock group were significantly higher than those in sepsis group and severe sepsis group (P 0.05), and had a high correlation with APACHE 鈪，

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