摘要
目的 分析辅助性T细胞(Th)1和Th2细胞因子对脓毒症继发急性肺损伤(ALI)严重程度的影响及其在评估脓毒症继发ALI中的作用。方法 回顾性收集自贡市第一人民医院2021年1月至2024年6月收治的206例脓毒症患者临床资料,根据是否继发ALI分为ALI组(62例)和单纯组(144例)。入院时对所有患者进行血清Th1细胞因子[γ干扰素(INF-γ)、肿瘤坏死因子α(TNF-α)]、Th2细胞因子[白细胞介素(IL)-4、IL-10]检测及急性生理学与慢性健康状况(APACHEⅡ)评分评估,并根据APACHEⅡ评分将ALI组患者分为低危组(<10分,25例)、中危组(10~20分,20例)和高危组(>20分,17例)。分析Th1和Th2细胞因子对脓毒症继发ALI严重程度的影响,及其在预测ALI发生中的作用。结果 脓毒症继发ALI患者中,IL-4、IL-10水平依低危组、中危组、高危组之序递降,IFN-γ水平及APACHEⅡ评分递升,差异均有统计学意义(P<0.05);低危组TNF-α水平低于中危组、高危组(P<0.05)。IL-4、IL-10与APACHEⅡ评分呈负相关(r=0.720,-0.539,P<0.01),IFN-γ、TNF-α与APACHEⅡ评分呈正相关(r=0.696,0.551,P<0.01)。Logistic回归分析显示,氧合指数低(β=-0.202,P<0.01)、IL-4水平低(β=-0.230,P<0.01)、IFN-γ水平高(β=1.106,P<0.01)、TNF-α水平高(β=0.012,P<0.05)为脓毒症继发ALI的独立危险因素。氧合指数、IL-4、IFN-γ、TNF-α评估脓毒症继发ALI的受试者工作特征(ROC)曲线下面积(AUC)分别为0.929、0.920、0.661、0.679。结论 Th1/Th2细胞因子与脓毒症继发ALI病情严重程度存在密切联系,低水平的氧合指数和IL-4,高水平的IFN-γ、TNF-α可促使脓毒症继发更严重的ALI,且该四项指标对脓毒症继发ALI的预测有一定临床参考价值。
Objective To analyze the effects of helper T cells(Th)1 and Th2 cytokines on the severity of acute lung injury(ALI)secondary to sepsis and to analyze their roles in evaluating the occurrence of ALI secondary to sepsis.Methods Clinical data of 206 patients with sepsis from Zigong First People’s Hospital from January 2021 to June 2024 were retrospectively collected,and they were divided into ALI group(62 cases)and simple group(144 cases)according to whether ALI was secondary or not.Serum Th1 cytokines[interferon-γ(INF-γ),tumor necrosis factorα(TNF-α)]and Th2 cytokines[interleukin(IL)-4,IL-10]were measured and the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores were evaluated for all patients at admission.Patients in ALI group were divided into low-risk group(<10,25 cases),medium-risk group(10-20,20 cases)and high-risk group(>20,17 cases)according to APACHEⅡscores.The effects of Th1 and Th2 cytokines on the severity of ALI secondary to sepsis and their roles in predicting the occurrence of ALI were analyzed.Results In patients of ALI secondary to sepsis,the levels of IL-4 and IL-10 decreased,while the levels of IFN-γand APACHEⅡscores increased,in the order of low-risk group,medium-risk group and high-risk group,with statistical significance(P<0.05).The level of TNF-αin low-risk group was lower than that in medium-risk group and high-risk group(P<0.05).IL-4 and IL-10 were negatively correlated with APACHEⅡscores(r=-0.720,-0.537,P<0.01),while IFN-γand TNF-αwere positively correlated with APACHEⅡscores(r=0.696,0.551,P<0.01).Logistic regression analysis showed that low oxygenation index(β=-0.202,P<0.01),low IL-4 level(β=-0.230,P<0.01),high IFN-γlevel(β=1.106,P<0.01),and high TNF-αlevel(β=0.012,P<0.05)were independent risk factors for ALI secondary to sepsis.The area under the receiver operating characteristic curve of oxygenation index,IL-4,IFN-γ,TNF-αin the evaluation of ALI secondary to sepsis was 0.929,0.920,0.661,0.679,respectively.Conclusion Th1/Th2 cytokines are closely related to the severity of ALI secondary to sepsis.High levels of oxygenation index and IL-4,and low levels of IFN-γand TNF-αcan promote more severe ALI secondary to sepsis,and these four indicators have certain clinical reference value for evaluating the prediction of ALI secondary to sepsis.
作者
傅道亮
陈德建
任磊
侯晓林
FU Daoliang;CHEN Dejian;REN Lei;HOU Xiaolin(Emergency Department,Zigong First People’s Hospital,Zigong Academy of Medical Sciences,Zigong,Sichuan 643000,China)
出处
《中国临床研究》
2025年第8期1197-1201,共5页
Chinese Journal of Clinical Research
基金
国家自然科学基金(81802079)。
