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目的:探讨白介素-27(IL-27)在脓毒症的早期诊断、判断严重程度及预测预后上的价值。方法:纳入2014年7月—2015年7月入住江苏大学附属宜兴市人民医院重症监护室(ICU)的全身炎症反应综合征(SRIS)患者,经感染筛查(血、痰、尿液培养和X胸片),参照2012年国际脓毒症定义指南标准诊断为脓毒症并归为脓毒症组,其余归为SIRS组。根据诊断标准,再将脓毒症患者分为脓毒症、严重脓毒症和脓毒性休克。在第1、3、7天采集血液样本测定其中IL-27和降钙素原(PCT)水平,分析两组间的IL-27和PCT差别,绘制ROC曲线并计算曲线下面积(AUC)来判断其诊断价值。采用Pearson相关系数计算两指标与APACHEⅡ的相关性来评估其对判断患者病情严重程度的价值。脓毒症组随访28 d调查预后。结果:共有118例,其中脓毒症组75例,SRIS组43例。脓毒症组中包含脓毒症53例、严重脓毒症14例,脓毒性休克8例。脓毒症组第1、3、7天IL-27和PCT水平均明显高于SIRS组(P<0.05),其中第1天升高最明显。IL-27的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78%和75%。IL-27联合PCT检测的AUC为0.884,敏感性、特异性分别为83%,88%。IL-27和PCT水平在脓毒性休克组明显高于脓毒症组和严重脓毒症组(P<0.05),并与APACHEⅡ有着较高的相关性,R2分别为0.659和0.827。28 d随访存活45例,死亡30例,死亡组IL-27和PCT水平明显高于存活组(P<0.05),两者均为影响脓毒症患者预后的独立危险因素(P<0.01)。结论:IL-27对脓毒症的早期诊断,严重程度的判断和预测预后均有一定帮助,但与PCT相比存在差距,联合检测IL-27和PCT对早期诊断脓毒症可以取得更好的效果。
Objective: To investigate the value of interleukin-27 (IL-27) in the early diagnosis, severity and prognosis of sepsis. Methods: Patients with systemic inflammatory response syndrome (SRIS) from July 2014 to July 2015 in ICU of Yixing People’s Hospital affiliated to Jiangsu University were enrolled in this study. They were screened by infection (blood, sputum, urine and X chest X-ray), with reference to the 2012 international guidelines for the definition of sepsis criteria for the diagnosis of sepsis and sepsis group, the rest as SIRS group. According to the diagnostic criteria, sepsis patients were divided into sepsis, severe sepsis and septic shock. Blood samples were collected on days 1, 3, and 7 to determine IL-27 and procalcitonin (PCT) levels. IL-27 and PCT differences between the two groups were analyzed, ROC curves were plotted and area under the curve To determine the diagnostic value. Pearson correlation coefficient was used to calculate the correlation between the two indicators and APACHE Ⅱ to evaluate the value of determining the severity of the patient’s condition. The sepsis group was followed up for 28 days to investigate the prognosis. Results: A total of 118 cases, including sepsis 75 cases, SRIS 43 cases. In the sepsis group, there were 53 cases of sepsis, 14 cases of severe sepsis and 8 cases of septic shock. The levels of IL-27 and PCT on the 1st, 3rd and 7th day in sepsis group were significantly higher than those in SIRS group (P <0.05), of which the most obvious increase was on the first day. The AUC of IL-27 was 0.745 with a sensitivity and specificity of 66% and 72%, respectively. The AUC of PCT was 0.836 with a sensitivity and specificity of 78% and 75%, respectively. The AUC of IL-27 in combination with PCT was 0.884 with sensitivity and specificity of 83% and 88%, respectively. The levels of 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 APACHEⅡ with R2 of 0.659 and 0.827.28 d respectively There were 45 survivors and 30 deaths. The levels of IL-27 and PCT in death group were significantly higher than those in survival group (P <0.05), both of which were independent risk factors influencing the prognosis of patients with sepsis (P <0.01). Conclusion: IL-27 may be helpful in the early diagnosis, severity judgment and prognosis of sepsis, but there is a gap compared with PCT. Combined detection of IL-27 and PCT can achieve better results in the early diagnosis of sepsis Effect.