IL-27和PCT联合检测在不同分型的脓毒症危重患者中的诊断价值
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摘要
目的:探讨白细胞介素-27(Interleukin 27,IL-27)对成人全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)和脓毒症的诊断价值。方法:214例SIRS患者按入院诊断结果及感染源不同分为非脓毒症组(n=80)、肺源性脓毒症组(n=73)和非肺源性脓毒症组(n=61)。采用酶联免疫吸附试验(ELISA)检测各组患者血清IL-27和降钙素原(PCT)水平;绘制受试者工作特征曲线(ROC),判断各指标的诊断价值,分析各生物标志物的性能,判断潜在的预测变量。结果:肺源性脓毒症患者体温符合SIRS标准的比例为65.8%,明显高于非脓毒症患者(45.0%)及非肺源性脓毒症患者(45.9%)(P<0.05);非肺源性脓毒症患者白细胞数符合SIRS标准的比例为68.9%,明显高于非脓毒症患者42.5%,(P<0.05)。确诊脓毒症后的患者血清IL-27的AUC为0.655,PCT的AUC为0.649。根据不同感染源进一步分析,肺源性和非肺源性脓毒症患者血清IL-27水平明显高于非脓毒症患者,肺源性和非肺源性脓毒症患者PCT水平明显高于非脓毒症患者(P<0.01)。ROC曲线分析发现,肺源性和非肺源性脓毒症患者血清IL-27的AUC分别为0.657和0.652,肺源性和非肺源性脓毒症患者PCT的AUC为0.667和0.629。分别联合检测三组患者的血清IL-27和PCT值,肺源性脓毒症患者的AUC为0.728,非肺源性脓毒症患者的AUC为0.703。对肺源性脓毒症患者与非肺源性脓毒症患者诊断的准确性均有所提升。结论:肺源性和非肺源性脓毒症患者较非脓毒症患者更加符合SIRS标准。IL-27作为脓毒症诊断的生物标志物,对病情变化的反应不敏感,而IL-27和PCT结合可以使诊断的准确性提高。
Objective: To evaluate interleukin-27(IL-27) as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome(SIRS) and sepsis. Methods: A total of 214 SIRS patients in department of critical care medicine in our hospital were enrolled. The patients were divided into no sepsis group(n=80), pulmonary original sepsis group(n=73), and non-pulmonary original sepsis group(n=61). Plasma IL-27 and procalcitonin(PCT) were determined with enzyme linked immunosorbent assay(ELISA). Receiver operating characteristic curve(ROC) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance. Results: The body temperature of patients with pulmonary sepsis was in accordance with the SIRS standard of65.8%, significantly higher than patients with non sepsis(45%) and non pulmonary origin sepsis(45.9%),(P<0.05); the ratio of white blood cell count comply with SIRS standards was 68.9%, was significantly higher than the non sepsis patients 42.5%(P<0.05). The AUC of IL-27 was 0.655 and AUC was 0.649 in the patients with sepsis. According to different source of infection, Serum IL-27 levels were significantly higher in patients with pulmonary and non pulmonary sepsis than in non sepsis patients, the level of PCT in patients with pulmonary and non pulmonary sepsis was significantly higher than those in non sepsis patients(P<0.01). ROC curve analysis, the AUC of IL-27 in the serum of patients with pulmonary and non pulmonary sepsis was 0.657 and 0.652, AUC of PCT was 0.667 and 0.629 in patients with pulmonary and non pulmonary origin. Combined detection of serum IL-27 and PCT in three groups of patients, respectively,AUC of patients with pulmonary origin sepsis was 0.728, AUC was 0.703 in patients with non pulmonary sepsis. The accuracy of the diagnosis of pulmonary sepsis and non pulmonary sepsis patients were improved. Conclusions: Patients with lung and non pulmonary origin sepsis were more in line with SIRS standards than those with non sepsis patients. IL-27 as a biomarker for the diagnosis of sepsis, was not sensitive to the changes of the disease. The combination of PCT and IL-27 can improve the accuracy of diagnosis.
Objective: To evaluate interleukin-27(IL-27) as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome(SIRS) and sepsis. Methods: A total of 214 SIRS patients in department of critical care medicine in our hospital were enrolled. The patients were divided into no sepsis group(n=80), pulmonary original sepsis group(n=73), and non-pulmonary original sepsis group(n=61). Plasma IL-27 and procalcitonin(PCT) were determined with enzyme linked immunosorbent assay(ELISA). Receiver operating characteristic curve(ROC) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance. Results: The body temperature of patients with pulmonary sepsis was in accordance with the SIRS standard of65.8%, significantly higher than patients with non sepsis(45%) and non pulmonary origin sepsis(45.9%),(P<0.05); the ratio of white blood cell count comply with SIRS standards was 68.9%, was significantly higher than the non sepsis patients 42.5%(P<0.05). The AUC of IL-27 was 0.655 and AUC was 0.649 in the patients with sepsis. According to different source of infection, Serum IL-27 levels were significantly higher in patients with pulmonary and non pulmonary sepsis than in non sepsis patients, the level of PCT in patients with pulmonary and non pulmonary sepsis was significantly higher than those in non sepsis patients(P<0.01). ROC curve analysis, the AUC of IL-27 in the serum of patients with pulmonary and non pulmonary sepsis was 0.657 and 0.652, AUC of PCT was 0.667 and 0.629 in patients with pulmonary and non pulmonary origin. Combined detection of serum IL-27 and PCT in three groups of patients, respectively,AUC of patients with pulmonary origin sepsis was 0.728, AUC was 0.703 in patients with non pulmonary sepsis. The accuracy of the diagnosis of pulmonary sepsis and non pulmonary sepsis patients were improved. Conclusions: Patients with lung and non pulmonary origin sepsis were more in line with SIRS standards than those with non sepsis patients. IL-27 as a biomarker for the diagnosis of sepsis, was not sensitive to the changes of the disease. The combination of PCT and IL-27 can improve the accuracy of diagnosis.
引文
[1]潘爱军,邓艳如,杨田军,等.脓毒症患者外周血自然杀伤细胞的表型和功能及其临床意义[J].中华危重病急救医学,2014,26(11):827-831Pan Ai-jun,Deng Yan-ru,Yang Tian-jun,et al.Natural killer cells in peripheral blood of patients with sepsis phenotype and function and its clinical significance[J].Chinese Journal of Critical Care Medicine,2014,26(11):827-831
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[10]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505Gao Ge,Feng Zhe,Chang Zhi-gang,et al.2012 World severe sepsis and septic shock treatment guidelines[J].Chinese Journal of Critical Care Medicine,2013,25(8):501-505
[11]梁英健,张晓娟,李鑫,等.脓毒症患者血中组织因子,血管性血友病因子与肿瘤坏死因子-α改变的临床意义[J].中国中西医结合急救杂志,2012,19(2):104-106Liang Ying-jian,Zhang Xiao-juan,Li Xin,et al.Tissue factor in the blood of patients with sepsis,the clinical significance of von Willebrand factor and tumor necrosis factor-αchange[J].Chinese and Western Medicine,2012,19(2):104-106
[12]Wong HR,Liu KD,Kangelaris KN,et al.Performance of interleukin-27 as a sepsis diagnostic biomarker in critically ill adults[J].J Crit Care,2014,29(5):718-722
[13]周晓瑞,卢家凯,张京岚.炎症介质在脓毒症心功能障碍中作用的研究进展[J].心肺血管病杂志,2012,31(06):762-764Zhou Xiao-rui,Lu Jia-kai,Zhang Jing-lan.Inflammatory mediators in cardiac dysfunction in sepsis[J].Cardiopulmonary and Vascular Disease,2012,31(06):762-764
[14]张红燕.脓毒症脑病的研究进展[J].医学理论与实践,2012,25(03):276-278Zhang Hong-yan.Research Sepsis encephalopathy[J].Medical Theory and Practice,2012,25(03):276-278
[15]刘彬彬,林东军.白细胞介素-27的生物学功能与应用前景[J].国际内科学杂志,2008,35(6):345-349Liu Bin-bin,Lin Dong-jun.The biological function and prospect of Interleukin-27[J].International Journal of Internal Medicine,2008,35(6):345-349
[16]汪宏良,翟中良,张海燕,等.白细胞介素27的研究进展[J].检验医学与临床,2010,7(6):553-554Wang Hong-liang,Zhai Zhong-liang,Zhang Hai-yan,et al.Progress of interleukin-27[J].Laboratory Medicine and Clinical,2010,7(6):553-554
[17]保勇,史梦,喻华,等.检测血清降钙素原对感染性疾病及脓毒症的诊断价值[J].实用医院临床杂志,2012,9(1):94-96Bao Yong,Shi Meng,Yu Hua,et al.Diagnostic value of serum procalcitonin infectious diseases and sepsis[J].CLINICAL,2012,9(1):94-96
[18]张敏,冯志顺,邓哲彤,等.血清降钙素原和C反应蛋白检测在脓毒症早期诊断中的意义[J].广东医学,2011,32(17):2260-2262Zhang Min,Feng Zhi-shun,Deng Zhe-tong,et al.Serum procalcitonin and C-reactive protein(CRP)is detected in the early diagnosis of sepsis[J].Guangdong Medicine,2011,32(17):2260-2262
[19]艾红梅.常用生物标记物在脓毒症中的应用现状及展望[J].实用医学杂志,2012,28(4):662-663Yi Hong-mei.Application Status and Prospects common biomark ers in sepsis[J].Practical Journal of Medicine,2012,28(4):662-663
[20]范江花,祝益民,张新萍.脓毒症患儿低蛋白血症与CRP及PCT的相关性[J].中国当代儿科杂志,2010,12(11):870-873Fan Jiang-hua,Zhu Yi-min,Zhang Xin-ping.Correlation in children with sepsis hypoalbuminemia and CRP and PCT[J].Chinese Journal of Contemporary Pediatrics,2010,12(11):870-873
[21]刘丽华,单保恩,张璁.IL-27信号通路与肿瘤[J].国际肿瘤杂志,2011,38(4):251-254Liu Li-hua,Shan bao-en,Zhang Cong.International Journal of Cancer IL-27 signaling pathway and tumor[J].Journal of International Oncology,2011,38(4):251-254
[22]曾昭静,吕小平.IL-27在炎症性肠病中的免疫调节作用[J].山东医药,2012,52(13):93-95Zeng Zhao-jing,Lv Xiao-ping.IL-27 immunoregulatory role in inflammatory bowel disease[J].Shandong Medical Journal,2012,52(13):93-95
[2]王静,李熙鸿.脓毒症发病机制的研究进展[J].实用儿科临床杂志,2012,27(10):786-789Wang Jing,Li Xi-hong.Research progress of sepsis pathogenesis[J].Applied Clinical Pediatrics,2012,27(10):786-789
[3]汤超,刘朝奇,韩强.脓毒症免疫干预措施的研究进展[J].中国全科医学,2013,16(9):1020-1022Tang Chao,Liu Zhao-qi,Han Qiang.Progress immune intervention in sepsis[J].Chinese General Practice,2013,16(9):1020-1022
[4]赵永祯,李春盛.生物标志物组合对急诊脓毒症和重度脓毒症患者的诊断价值[J].中华危重病急救医学,2014,26(3):153-158Zhao Yong-zhen,Li Chun-sheng.The diagnostic value of biomarkers combination of emergency sepsis and severe sepsis patients[J].Chinese Journal of Critical Care Medicine,2014,26(3):153-158
[5]Scicluna BP,van der Poll T.Interleukin-27:a potential new sepsis biomarker exposed through genome-wide transcriptional profiling[J].Crit Care,2012,16(6):188
[6]Wong HR,Cvijanovich NZ,Hall M,et al.Interleukin-27 is a novel candidate diagnostic biomarker for bacterial infection in critically ill children[J].Crit Care,2012,16(5):R213
[7]中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南[J].中华结核和呼吸杂志,2006,29(10):651-655Chinese Medical Association for respiratory diseases.Community-acquired pneumonia diagnosis and treatment guidelines[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2006,29(10):651-655
[8]姚咏明,盛志勇,林洪远,等.2001年国际脓毒症定义会议关于脓毒症诊断的新标准[J].中国危重病急救医学,2006,18(11):645-646Yao Yong-ming,Sheng Zhi-yong,Lin Hong-yuan,et al.New standard 2001 international conference on the definition of sepsis Sepsis diagnosis[J].Chinese Critical Care Medicine,2006,18(11):645-646
[9]姚咏明,盛志勇,林洪远,等.脓毒症定义及诊断的新认识[J].中华危重病急救医学,2004,16(6):321-324Yao Yong-ming,Sheng Zhi-yong,Lin Hong-yuan,et al.New understanding of the definition and diagnosis of sepsis[J].Chinese Journal of Critical Care Medicine,2004,16(6):321-324
[10]高戈,冯喆,常志刚,等.2012国际严重脓毒症及脓毒性休克诊疗指南[J].中华危重病急救医学,2013,25(8):501-505Gao Ge,Feng Zhe,Chang Zhi-gang,et al.2012 World severe sepsis and septic shock treatment guidelines[J].Chinese Journal of Critical Care Medicine,2013,25(8):501-505
[11]梁英健,张晓娟,李鑫,等.脓毒症患者血中组织因子,血管性血友病因子与肿瘤坏死因子-α改变的临床意义[J].中国中西医结合急救杂志,2012,19(2):104-106Liang Ying-jian,Zhang Xiao-juan,Li Xin,et al.Tissue factor in the blood of patients with sepsis,the clinical significance of von Willebrand factor and tumor necrosis factor-αchange[J].Chinese and Western Medicine,2012,19(2):104-106
[12]Wong HR,Liu KD,Kangelaris KN,et al.Performance of interleukin-27 as a sepsis diagnostic biomarker in critically ill adults[J].J Crit Care,2014,29(5):718-722
[13]周晓瑞,卢家凯,张京岚.炎症介质在脓毒症心功能障碍中作用的研究进展[J].心肺血管病杂志,2012,31(06):762-764Zhou Xiao-rui,Lu Jia-kai,Zhang Jing-lan.Inflammatory mediators in cardiac dysfunction in sepsis[J].Cardiopulmonary and Vascular Disease,2012,31(06):762-764
[14]张红燕.脓毒症脑病的研究进展[J].医学理论与实践,2012,25(03):276-278Zhang Hong-yan.Research Sepsis encephalopathy[J].Medical Theory and Practice,2012,25(03):276-278
[15]刘彬彬,林东军.白细胞介素-27的生物学功能与应用前景[J].国际内科学杂志,2008,35(6):345-349Liu Bin-bin,Lin Dong-jun.The biological function and prospect of Interleukin-27[J].International Journal of Internal Medicine,2008,35(6):345-349
[16]汪宏良,翟中良,张海燕,等.白细胞介素27的研究进展[J].检验医学与临床,2010,7(6):553-554Wang Hong-liang,Zhai Zhong-liang,Zhang Hai-yan,et al.Progress of interleukin-27[J].Laboratory Medicine and Clinical,2010,7(6):553-554
[17]保勇,史梦,喻华,等.检测血清降钙素原对感染性疾病及脓毒症的诊断价值[J].实用医院临床杂志,2012,9(1):94-96Bao Yong,Shi Meng,Yu Hua,et al.Diagnostic value of serum procalcitonin infectious diseases and sepsis[J].CLINICAL,2012,9(1):94-96
[18]张敏,冯志顺,邓哲彤,等.血清降钙素原和C反应蛋白检测在脓毒症早期诊断中的意义[J].广东医学,2011,32(17):2260-2262Zhang Min,Feng Zhi-shun,Deng Zhe-tong,et al.Serum procalcitonin and C-reactive protein(CRP)is detected in the early diagnosis of sepsis[J].Guangdong Medicine,2011,32(17):2260-2262
[19]艾红梅.常用生物标记物在脓毒症中的应用现状及展望[J].实用医学杂志,2012,28(4):662-663Yi Hong-mei.Application Status and Prospects common biomark ers in sepsis[J].Practical Journal of Medicine,2012,28(4):662-663
[20]范江花,祝益民,张新萍.脓毒症患儿低蛋白血症与CRP及PCT的相关性[J].中国当代儿科杂志,2010,12(11):870-873Fan Jiang-hua,Zhu Yi-min,Zhang Xin-ping.Correlation in children with sepsis hypoalbuminemia and CRP and PCT[J].Chinese Journal of Contemporary Pediatrics,2010,12(11):870-873
[21]刘丽华,单保恩,张璁.IL-27信号通路与肿瘤[J].国际肿瘤杂志,2011,38(4):251-254Liu Li-hua,Shan bao-en,Zhang Cong.International Journal of Cancer IL-27 signaling pathway and tumor[J].Journal of International Oncology,2011,38(4):251-254
[22]曾昭静,吕小平.IL-27在炎症性肠病中的免疫调节作用[J].山东医药,2012,52(13):93-95Zeng Zhao-jing,Lv Xiao-ping.IL-27 immunoregulatory role in inflammatory bowel disease[J].Shandong Medical Journal,2012,52(13):93-95