白介素-6联合CD4+T淋巴细胞百分比对脓毒症患者预后的评估价值

doi:10.16138/j.1673-6087.2021.06.007

摘要/Abstract

摘要：

目的：评估白介素-6（interleukin-6,IL-6）联合CD4⁺T淋巴细胞百分比对脓毒症患者预后的价值。方法：收集2016年6月至2019年6月我院急诊医学科158例脓毒症患者资料,如入院24 h内IL-6、CD4⁺T淋巴细胞百分比、CD4⁺T淋巴细胞、C反应蛋白（C-reactive protein, CRP）、降钙素原（procalcitonin, PCT）、人白细胞DR抗原（human leukocyte DR antigen, HLA-DR）,以及计算患者的脓毒症相关性器官功能衰竭评价（sepsis-related organ failure assessment,SOFA）评分、急性生理和慢性健康状况评价Ⅱ（acute physiology and chronic health evaluation-Ⅱ,APACHEⅡ）评分,根据28 d预后情况分为存活组和死亡组,比较2组SOFA评分、APACHEⅡ评分、IL-6、CD4⁺T淋巴细胞百分比、CD4⁺T淋巴细胞、CRP、PCT、HLA-DR的差异,分析IL-6、CD4⁺T淋巴细胞百分比与APACHEⅡ评分、SOFA评分的相关性,绘制受试者操作特征（receiver operating characteristic, ROC）曲线,评估以上各因素、IL-6、CD4⁺T淋巴细胞百分比及两者联合对脓毒症预后的判断价值。结果：死亡组APACHEⅡ评分（t=4.514,P<0.001）、SOFA评分（t=4.711,P<0.001）、IL-6（Z=2.114,P=0.035）、PCT（t=2.192,P=0.021）、CRP（Z=2.208,P=0.033）、D-二聚体（Z=1.963,P=0.043）高于存活组;死亡组CD4⁺T淋巴细胞百分比（Z=2.398,P=0.016）、HLA-DR（t=2.004,P=0.040）较存活组显著降低。将IL-6、CD4⁺T淋巴细胞百分比与APACHEⅡ评分、SOFA评分进行Spearman相关性分析,结果显示IL-6与APACHEⅡ评分、SOFA评分呈正相关（r=0.351、0.478,均P<0.05）,CD4⁺T淋巴细胞百分比与APACHEⅡ评分、SOFA评分呈负相关（r=-0.347、-0305,均P<0.05）。ROC曲线示IL-6联合 CD4⁺T淋巴细胞百分比的曲线下面积（area under the curve, AUC）（0.793,P<0.001）最高,灵敏度为86.7%,特异度为63.0%,两因素联合的预测效果较单一指标更好。结论：IL-6联合CD4⁺T淋巴细胞百分比是判断脓毒症的预后的因素,两因素联合较单一指标评估效果更佳。

关键词: 脓毒症, 白介素-6, CD4⁺T淋巴细胞百分比

Abstract:

Objective To evaluate the value of interleukin （IL）-6 combined with CD4⁺ T lymphocyte percentage on prognosis in the patients with sepsis. Methods The data of 158 patients with sepsis in the emergency medical department of our hospital from June 2016 to June 2019 were collected, which included IL-6 level, CD4⁺ T lymphocyte percentage, CD4⁺ T lymphocyte, C-reactive protein (CRP), procalcitonin (PCT）, human leukocyte DR antigen (HLA-DR), and calculation of patients’ sepsis-related organ failure assessment(SOFA) score and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ) score within 24 h after admission. The patients were divided into survival group and death group according to the prognosis after 28 d, and the difference of the SOFA score, APACHE Ⅱ score, IL-6, CD4⁺ T lymphocyte percentage, the correlation between IL-6, CD4⁺ T lymphocyte percentage and SOFA score was analyzed, the receiver operating characteristic (ROC) curve was drawn, and the prognostic value of IL-6, CD4⁺ T lymphocyte percentage and their combination on the patients with sepsis was evaluated. Results APACHE Ⅱ score (t=4.514, P<0.001), SOFA score (t=4.711, P<0.001), IL-6 (Z=2.114, P=0.035), PCT (t=2.192, P=0.021),CRP (Z=2.208, P=0.033) and D-dimmer (Z=1.963, P=0.043) in the death group were significantly higher than those in the survival group, while the percentage of CD4⁺ T lymphocytes (Z=2.398, P=0.016) and HLA-DR(t=2.004,P=0.040) in the death group were significantly lower than that in the survival group. Spearman correlation analysis of IL-6, CD4⁺ T lymphocyte percentage and SOFA showed that IL-6 was positively correlated with SOFA score (r=0.478, P<0.001) and APACHEⅡscore(r=0.351, P=0.024). CD4⁺ T lymphocyte percentage was negatively correlated with SOFA score(r=-0.305, P=0.043) and APACHEⅡscore(r=-0.347, P=0.031). ROC curve showed that IL-6 combined with CD4⁺ T lymphocyte percentage [area under the curve(AUC)=0.793] had better prognostic value for the patients with sepsis than both APACHE Ⅱ score(AUC=0.732) and SOFA score(AUC=0.750), with sensitivity of 86.7% and specificity of 63.0%. The predictive effect of the combination of two factors was better than that of single index. Conclusions IL-6 combined with CD4⁺T lymphocyte percentage can evaluate the prognosis of the patients with sepsis, and the combination of two indexed is better than using single index.

Key words: Sepsis, Interleukin-6, Percentage of CD4⁺ T lymphocytes

中图分类号:

R631

王虎, 张姣姣, 孙俊楠, 王海嵘. 白介素-6联合CD4⁺T淋巴细胞百分比对脓毒症患者预后的评估价值[J]. 内科理论与实践, 2021, 16(06): 404-408.

WANG Hu, ZHANG Jiaojiao, SUN Junnan, WANG Hairong. Evaluating value of interleukin-6 combined with CD4⁺ T cell percentage on prognosis in patients with sepsis[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(06): 404-408.

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项目	存活组（n=127）	死亡组（n=31）	t/χ²/Z	P
男性[n（%）]	66（52.0）	18（58.1）	0.372	0.542
年龄（岁）	71.17±16.72	76.23±10.74	1.602	0.111
APACHEⅡ评分（分）	15.39±6.12	21.19±5.94	4.514	<0.001
SOFA评分（分）	5.23±2.94	8.71±3.72	4.711	<0.001
基础疾病[n（%）]
高血压病	73（57.5）	14（45.2）	1.528	0.216
糖尿病	36（28.3）	5（16.1）	1.936	0.164
冠心病	50（39.4）	14（45.2）	0.347	0.556
脑血管疾病	25（19.7）	5（16.1）	0.205	0.651
慢性肾脏病	14（11.0）	3（9.7）	0.047	1.000
原发疾病[n（%）]
肺炎	51（40.2）	14（45.1）	-	-
消化系统感染	21（16.5）	6（19.4）	-	-
泌尿系统感染	14（11.0）	3（9.7）	-	-
颅内感染	11（8.7）	3（9.7）	-	-
其他	30（23.6）	5（16.1）	-	-
PCT（mg/L）	11.09±1.49	24.59±3.90	2.192	0.021
CRP（mg/L）	122.00（62.00,174.00）	160.00（73.00,196.00）	2.208	0.033
IL-6（ng/L）	34.70(15.85,84.70)	138.50(14.50,861.00)	2.114	0.035
HLA-DR	1 865.38±601.41	1 206.74±633.32	2.004	0.040
D-二聚体（mg/L）	1.17（0.73,2.64）	2.86（1.13,5.95）	1.963	0.043
CD4⁺T淋巴细胞（个/μL）	271.8(172.5,432.3)	193.0(84.0,359.0)	1.827	0.068
CD4⁺T细胞百分比（%）	38.07(31.80,45.36)	31.10(19.95,37.50)	2.398	0.016

变量	AUC	P	95%CI	截断值	灵敏度（%）	特异度（%）
SOFA评分	0.750	0.002	0.610~0.890	5.5	80.0	63.0
APACHEⅡ评分	0.732	0.004	0.601~0.862	18.5	66.7	72.2
CD4⁺T淋巴细胞百分比	0.673	0.030	0.505~0.841	35.9	80.1	55.6
IL-6	0.683	0.015	0.520~0.867	68.1	73.3	71.3
PCT	0.694	0.011	0.505~0.861	17.7	75.1	65.3
CRP	0.675	0.038	0.470~0.896	137.0	74.3	61.8
HLA-DR	0.624	0.149	0.416~0.832	1 498.5	50.0	83.7
IL-6联合CD4⁺T细胞百分比	0.793	<0.001	0.684~0.901	0.1	86.7	63.0