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重症监护病房(intensive care unit,ICU)病人发生重症感染明显增加了死亡危险性,医院感染是抢救失败的重要原因之一。老年感染病人症状不典型、病情变化迅速,因此早期预测感染及采取有效的防止措施是改善病人预后、提高生存率的关键[1]。感染急性期反应是通过炎症细胞因子和神经内分泌系统共同作用而介导的。白细胞介素6(interleukin-6,IL-6)和肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)是参与免疫生理过程的重要促炎细胞因子,有广泛的生物活性[2]。IL-6和TNF-α与感染性疾病的发病有关,是参与脓毒症、全身反应综合征和多器官功能衰竭的重要炎症介质,其水平的高低可以反映感染的严重程度[3-4]。急性生理和慢性健康状况(APACHEⅡ)评分是ICU常用的评分系统,用于病人病情程度和预后的评价[5-6]。本研究旨在探讨IL-6、TNF-α和APACHEⅡ评分对ICU老年重症感染病人预后的评估价值。
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脓毒症组、严重脓毒症组、脓毒症休克组病人IL-6、TNF-α水平和APACHEⅡ评分均依次升高(P < 0.05~P < 0.01)(见表 1)。
分组 n IL-6/(ng/L) TNF-α/(ng/L) APACHEⅡ/分 脓毒症组 35 225.68±56.34 156.22±26.76 14.00±3.60 严重脓毒症组 24 267.98±89.14* 186.00±45.11** 18.12±3.33** 脓毒症休克组 19 319.54±99.07**△ 199.35±44.26**△ 23.03±4.00**△△ F — 8.82 9.32 38.84 P — < 0.01 < 0.01 < 0.01 MS组内 — 6 231.291 1 418.818 13.116 q检验:与脓毒症组比较*P < 0.05,**P < 0.01;与严重脓毒症组比较△P < 0.05,△△P < 0.01 表 1 不同病情病人IL-6、TNF-α水平和APACHEⅡ评分比较(x±s)
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存活组IL-6水平和APACHEⅡ评分均明显低于死亡组(P < 0.01),2组TNF-α水平差异无统计学意义(P>0.05)(见表 2)。
分组 n IL-6/(ng/L) TNF-α/(ng/L) APACHEⅡ/分 存活组 60 245.58±44.64 166.27±25.06 16.15±3.92 死亡组 18 317.98±90.14 189.00±50.91 22.62±5.13 t — 3.29 1.83 5.70 P — < 0.01 >0.05 < 0.01 表 2 不同预后病人各指标的比较(x±s)
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IL-6、TNF-α和APACHEⅡ评分三者间均呈正相关关系(P < 0.05~P < 0.01)(见表 3)。
指标 r P IL-6、TNF-α 0.801 < 0.01 IL-6、APACHEⅡ 0.714 < 0.05 TNF-α、APACHEⅡ 0.703 < 0.05 表 3 IL-6、TNF-α和APACHEⅡ评分的相关性
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IL-6、TNF-α和APACHEⅡ评分联合检测的ROC曲线下面积(AUC)为0.854,高于三者单独检测(P < 0.05)(见表 4)。
指标 AUC 95%CI P 敏感度/% 特异度/% IL-6 0.678 0.791~0.954 < 0.05 83.24 81.21 TNF-α 0.600 0.775~0.934 < 0.05 80.45 79.14 APACHEⅡ 0.691 0.710~0.932 < 0.05 80.11 80.67 联合指标 0.854 0.701~0.954 < 0.05 90.24 85.21 表 4 IL-6、TNF-α和APACHEⅡ评分预测预后的价值
IL-6、TNF-α与APACHEⅡ评分判断ICU老年重症感染病人预后的价值
Prognostic value of the levels of IL-6 and TNF-α, and APACHE Ⅱ score in elderly patients with severe infection in ICU
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摘要:
目的探讨白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)与急性生理和慢性健康状况(APACHEⅡ)评分判断ICU老年重症感染病人预后的价值。 方法选择ICU住院的老年脓毒症病人78例,按病情严重程度将病人分为脓毒症组(n=35)、严重脓毒症组(n=24)和脓毒症休克组(n=19);根据预后将病人分为存活组(n=60)和死亡组(n=18)。采用酶联免疫吸附试验检测血清中IL-6和TNF-α的水平,并对病人进行APACHE Ⅱ评分。采用受试者工作特征曲线(ROC)分析法评价各指标对病人预后的价值。 结果脓毒症组、严重脓毒症组、脓毒症休克组病人IL-6、TNF-α水平和APACHEⅡ评分均依次升高(P < 0.05~P < 0.01)。存活组IL-6和APACHEⅡ评分均明显低于死亡组(P < 0.01),2组TNF-α水平差异无统计学意义(P>0.05)。IL-6、TNF-α和APACHEⅡ评分三者间均呈正相关关系(P < 0.05~P < 0.01)。IL-6、TNF-α和APACHEⅡ评分联合检测的ROC曲线下面积为0.854,高于三者单独检测(P < 0.05)。 结论IL-6、TNF-α、APACHEⅡ评分均对ICU老年重症感染病人的预后有一定的评估价值,三者联合检测可提高预测价值。 Abstract:ObjectiveTo observe the prognostic value of the levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α), and acute physiology and chronic health score(APACHE)Ⅱ score in elderly patients with severe infection in intensive care unit(ICU). MethodsSeventy-eight elderly patients were divided into the sepsis group(n=35), severe sepsis group(n=24) and septic shock group(n=19) according to the severity of the disease.According to the prognosis, the patients were divided into the survival group(n=60) and death group(n=18).Receiver operating characteristic (ROC)curve was used to evaluate the prognostic value of each index. ResultsThe levels of IL-6 and TNF-α, and APACHEⅡ score of patients in the sepsis group, severe sepsis group and septic shock group gradually increased(P < 0.05 to P < 0.01).The IL-6 level and APACHEⅡ score in survival group were significantly lower than those in death group(P < 0.01), and there was no statistical significance in the TNF-α level between two groups(P>0.05).The levels of IL-6 and TNF-α, and APACHEⅡ score were all positively correlated(P < 0.05 to P < 0.01).The area under the ROC curve of the combined detection of IL-6, TNF-α and APACHE Ⅱ scores was 0.854, which was significantly higher than that of the three alone(0.678, 0.600 and 0.691, respectively) (P < 0.05). ConclusionsThe levels of IL-6 and TNF-α, and APACHE Ⅱ score have certain values in evaluating the prognosis of elderly patients with severe infection in ICU, and the combined detection can improve the prognosis value. -
Key words:
- intensive care unit /
- old age /
- interleukin-6 /
- tumor necrosis factor-α /
- APACHEⅡ score /
- infection
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表 1 不同病情病人IL-6、TNF-α水平和APACHEⅡ评分比较(x±s)
分组 n IL-6/(ng/L) TNF-α/(ng/L) APACHEⅡ/分 脓毒症组 35 225.68±56.34 156.22±26.76 14.00±3.60 严重脓毒症组 24 267.98±89.14* 186.00±45.11** 18.12±3.33** 脓毒症休克组 19 319.54±99.07**△ 199.35±44.26**△ 23.03±4.00**△△ F — 8.82 9.32 38.84 P — < 0.01 < 0.01 < 0.01 MS组内 — 6 231.291 1 418.818 13.116 q检验:与脓毒症组比较*P < 0.05,**P < 0.01;与严重脓毒症组比较△P < 0.05,△△P < 0.01 表 2 不同预后病人各指标的比较(x±s)
分组 n IL-6/(ng/L) TNF-α/(ng/L) APACHEⅡ/分 存活组 60 245.58±44.64 166.27±25.06 16.15±3.92 死亡组 18 317.98±90.14 189.00±50.91 22.62±5.13 t — 3.29 1.83 5.70 P — < 0.01 >0.05 < 0.01 表 3 IL-6、TNF-α和APACHEⅡ评分的相关性
指标 r P IL-6、TNF-α 0.801 < 0.01 IL-6、APACHEⅡ 0.714 < 0.05 TNF-α、APACHEⅡ 0.703 < 0.05 表 4 IL-6、TNF-α和APACHEⅡ评分预测预后的价值
指标 AUC 95%CI P 敏感度/% 特异度/% IL-6 0.678 0.791~0.954 < 0.05 83.24 81.21 TNF-α 0.600 0.775~0.934 < 0.05 80.45 79.14 APACHEⅡ 0.691 0.710~0.932 < 0.05 80.11 80.67 联合指标 0.854 0.701~0.954 < 0.05 90.24 85.21 -
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