【作者】 杨宏富；

【导师】 孙荣青；

【作者基本信息】 郑州大学 ， 急诊医学， 2010， 硕士

【摘要】 目的研究脓毒症患者血浆的IL-18表达水平以及IL-18表达水平与脓毒症临床严重程度、预后之间的关系。评价IL-18在脓毒症病情严重程度及预后判断中的应用价值。方法观察2008年7月至2009年6月之间郑州大学第一附属医院ICU的89例患者,其中病例组61例,对照组28例。收集患者入ICU时的生命体征(包括体温、呼吸、脉搏、血压)、血常规、肝功能、肾功能、凝血功能,并进行SOFA评分、APACHEⅡ评分和GCS评分。同时抽静脉血查C反应蛋白(CRP)、乳酸、血浆IL-18浓度。分析脓毒症患者IL-18表达水平与临床严重程度、预后之间的关系。’评价IL-18对脓毒症病情严重程度及预后判断的应用价值。结果病例组与对照组的生命体征,血常规、肝功能,肾功能,凝血功能和免疫功能比较均无统计学意义。病例组的SOFA评分高于对照组,有统计学意义(P<0.005)。病例组和对照组的APACHEⅡ评分、GCS评分之间无统计学差异。病例组的IL-18水平(P=0.008)、CRP(P<0.001)、乳酸(P=0.01)高于对照组。脓毒性休克组患者的平均动脉压、纤维蛋白原和动脉血气的pH值低于非脓毒性休克组(P<0.05)。脓毒性休克患者的总胆红素、尿素氮高于非脓毒性休克组,均有统计学意义(P<0.05)。脓毒性休克组患者SOFA评分(P<0.001)、APACHEII评分(P=0.004)高于非脓毒性休克组；脓毒性休克组与非脓毒性休克组患者的GCS评分无统计学差异。脓毒性休克组患者的IL-18(P<0.001)、CRP(P=0.018)高于非脓毒性休克组；脓毒性休克组与非脓毒性休克组患者的血乳酸无统计学差异。生存组的脓毒症患者纤维蛋白原高于死亡组(P=-0.004)；生存组的脓毒症患者总胆红素低于死亡组(P=0.001)。死亡组的脓毒症患者的SOFA评分(P <0.001)、APACHEⅡ评分(P=0.047)高于生存组。死亡组的脓毒症患者的GCS评分低于生存组(P=0.012)。死亡组脓毒症患者的IL-18(P=0.001)、CRP(P=0.001)高于生存组；死亡组与生存组脓毒症患者的血乳酸无统计学差异。脓毒症的IL-18的受试者工作特征(ROC)曲线下面积为0.912[95%CI(0.770-1.000),P<0.001];CRP的ROC曲线下面积为0.850[95%CI(0.753-0.946),P<0.001]。结论IL-18可用于脓毒症患者严重程度及预后的判断。IL-18对脓毒症的诊断价值等同或不低于CRP。更多还原

【Abstract】 ObjectiveTo investigate the expressing levels of serum IL-18 in patients with sepsis, find the relationships between the levels of IL-18 and the severity, prognosis of sepsis, and then evaluate the value of IL-18 in the severity and prognostic of sepsis.MethodsEighty-nine patients enrolled in ICU of the First Affiliated Hospital of Zhengzhou University from July 2008 to June 2009 period were observed. They were divided into two groups:case group (n=61) and control group (n=28). The vital signs (including body temperature, respiration, pulse, blood pressure), blood routine, liver function, kidney function, blood coagulation were recorded. SOFA score, APACHEⅡscore and GCS score of patients were calculated. Serum IL-18, C-reactive protein (CRP) and lactate concentration were detected. The relationships between serum IL-18 and severity, prognosis of sepsis were statistical analyzed. The value of IL-18 in evaluation and prognosis in sepsis was assessed.ResultsThere were no statistical difference of vital signs, blood routine, liver function, kidney function, blood coagulation between patients of the two groups. SOFA score of the case group was higher than that of the control group. There were no statistical difference of APACHE II score and GCS score between the two groups.IL-18 (P= 0.008) and CRP (P<0.001) of the case group were higher than that of the control group.MAP, FIB and the pH value in the septic shock group were lower than that of the non-septic shock group (P<0.05). The TBIL, BUN of septic shock group were higher than that of the non-septic shock group (P<0.05). SOFA score (P<0.001), APACHE II score (P=0.004) of septic shock group were higher than that of the non-septic shock group.GCS score was no statistical difference between the two groups. The serum IL-18 levels (P<0.001) and CRP (P=0.018) in the septic shock group was higher than that of the non-septic shock group. The lactic acid was no statistical difference between two groups.The FIB of the survival group was higher than that of the death group (P=0.004), TBIL of the survival group was lower than that of the death group (P=0.001).SOFA score (P<0.001), APACHE II score (P=0.047) of the death group were higher than that of the survival group. GCS of the death group was lower than that of the survival group (P=0.012). IL-18 (P=0.001) and CRP (P=0.001) of the death group were higher than that of the survival group.The lactic acid was no statistical difference between the two groups.The ROC area under the curve of IL-18 in sepsis was 0.912 [95% CI (0.770-1.000), P<0.001], CRP was 0.850 [95% CI (0.753-0.946), P<0.001]. The value of IL-18 was higher than CRP in the diagnosis of sepsis.ConclusionsIL-18 can be used for severity and prognosis of the patients with sepsis. The value of blood IL-18 was not lower than CRP in the diagnosis of sepsis.更多还原