摘要
目的探讨外周血6种白介素水平对脓毒症相关血小板减少患者的早期诊断价值。方法选取2017年7月—2020年6月上海交通大学附属第一人民医院重症监护室确诊的脓毒症患者169例为研究对象。根据确诊第1天血小板数量是否>100×10^(9)/L分为血小板减少组(n=76)和血小板正常组(n=93)。采集患者的基线资料,比较2组外周血6种白介素(白介素-1、白介素-2R、白介素-6、白介素-8、白介素-10、TNF-α)水平,并分析其与脓毒症相关血小板减少的相关性。结果与血小板正常组比较,血小板减少组的序贯器官功能衰竭(SOFA)评分、APACHEⅡ评分、呼吸道感染比例、血流感染比例、病死率更高,差异均有统计学意义(Z/χ^(2)/P=2.275/0.000、4.237/0.023、4.803/0.028、8.197/0.004、7.623/0.006);血小板减少组患者的白介素-2R、白介素-6、白介素-10和TNF-α均明显升高(Z/P=2.996/0.003、3.567/0.000、3.812/0.000、2.383/0.017)。ROC曲线分析发现,白介素-2R、白介素-6、白介素-10和TNF-α对脓毒症相关血小板减少均具有一定的预测价值[AUC(95%CI)=0.634(0.549~0.719)、0.660(0.576~0.743)、0.669(0.585~0.754)、0.607(0.519~0.695)]。多因素Logistic回归分析发现,SOFA评分和白介素-6升高是脓毒症相关血小板减少的独立危险因素[OR(95%CI)=1.254(1.072~1.468)、1.001(1.000~1.002)]。基于多因素分析结果,以SOFA评分和白介素6构建的多参数模型,预测脓毒症相关血小板减少的AUC为0.732,最佳临界值为0.394,敏感度0.684,特异度0.710。结论白介素6和SOFA评分构建的多参数模型对脓毒症相关血小板减少的发生具有良好的预测价值。
Objective To explore the value of six interleukins in peripheral blood in the early diagnosis of patients with sepsis-related thrombocytopenia.Methods 169 patients with sepsis diagnosed in the intensive care unit of the First People's Hospital of Shanghai Jiaotong University from July 2017 to June 2020 were selected as the research objects.According to whether the number of platelets on the first day of diagnosis was greater than 100×10^(9)/L,they were divided into thrombocytopenia group(n=76)and normal platelet group(n=93).The baseline data of patients were collected,and the levels of 6 interleukins(interleukin-1,interleukin-2R,interleukin-6,interleukin-8,interleukin-10,and TNF-α)in the peripheral blood of the two groups were compared,and their correlation with sepsis-related thrombocytopenia was analyzed.Results Compared with the normal platelet group,the SOFA score,APACHEⅡscore of the thrombocytopenia group had higher respiratory infections,bloodstream infections,and mortality rates,and the differences were statistically significant(Z/χ^(2)/P=2.275/0.000,4.237/0.023,4.803/0.028,8.197/0.004,7.623/0.006).In patients with thrombocytopenia,interleukin-2R,interleukin-6,interleukin-10 and TNF-αwere all significantly increased(Z/P=2.996/0.003,3.567/0.000,3.812/0.000,2.383/0.017).ROC curve analysis found that interleukin-2R,interleukin-6,interleukin-10 and TNF-αhave certain predictive value for sepsis-related thrombocytopenia[AUC(95%CI)=0.634(0.549-0.719),0.660(0.576-0.743),0.669(0.585-0.754),0.607(0.519-0.695)].Multivariate Logistic analysis found that elevated SOFA score and interleukin-6 were independent risk factors for sepsis-related thrombocytopenia[OR(95%CI)=1.254(1.072-1.468),1.001(1.000-1.002)].Based on multivariate analysis As a result,the multi-parameter model constructed with SOFA score and interleukin-6 predicts the AUC of sepsis-related thrombocytopenia is 0.732,the best cut-off value is 0.394,the sensitivity is 0.684,and the specificity is 0.710.Conclusion The multi-parameter model constructed by interleukin-6 and SOFA score has good predictive value for the occurrence of sepsis-related thrombocytopenia.
作者
李明
周志刚
王伟琴
王瑞兰
黄培杰
Li Ming;Zhou Zhigang;Wang Weiqin;Wang Ruilan;Huang Peijie(Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China)
出处
《疑难病杂志》
CAS
2021年第10期1022-1026,共5页
Chinese Journal of Difficult and Complicated Cases
基金
国家自然科学基金资助项目(81471891)。
