外周血Th1/Th2、Treg/Th17细胞因子对重症脓毒症病人近期预后的预测价值

目的探讨外周血Th1/Th2、Treg/Th17细胞因子对重症脓毒症病人近期预后的预测价值。方法将120例重症脓毒症病人作为观察组，另选取同期健康体检者103名作为对照组，均行外周血Th1/Th2细胞因子γ-干扰素(IFN-γ)、白细胞介素(IL)-4]、Treg/Th17细胞因子转化生长因子β(TGF-β)、IL-17]水平检测并对比。所有病人均随访观察28 d，根据观察组病人存活情况将其分为死亡组与生存组，对比2组外周血IFN-γ、IL-4、TGF-β、IL-17、IFN-γ/IL-4、TGF-β/IL-17水平，采用多因素logistic回归性分析法分析各细胞因子水平与重症脓毒症病人近期死亡的关系，另采用ROC曲线分析各指标对重症脓毒症病人近期死亡的预测价值。结果观察组外周血IFN-γ、IL-4、TGF-β、IL-17水平均高于对照组(P < 0.01)，IFN-γ/IL-4、TGF-β/IL-17均低于对照组(P < 0.01)；病人28 d病死率为25.00%；死亡组外周血IFN-γ、IL-4、TGF-β、IL-17水平均高于存活组(P < 0.01)，IFN-γ/IL-4、TGF-β/IL-17均低于存活组(P < 0.01)；年龄增大，APACHE-Ⅱ评分和SOFA评分高，血肌酐、IFN-γ、IL-4、TGF-β、IL-17水平升高是影响病人近期死亡的危险因素，IFN-γ/IL-4、TGF-β/IL-17比值降低是病人近期死亡的保护因素(P < 0.05~P < 0.01)；外周血IFN-γ、IL-4、TGF-β、IL-17水平联合预测重症脓毒症病人住院28 d内死亡的灵敏度高于单独预测，AUC高于单独预测(P < 0.01)；IFN-γ/IL-4、TGF-β/IL-17联合预测重症脓毒症病人近期死亡的灵敏度高于单独预测，AUC高于单独预测(P < 0.01)。结论重症脓毒症病人外周血IFN-γ、IL-4、TGF-β、IL-17水平均异常升高，IFN-γ/IL-4、TGF-β/IL-17均降低，且其水平变化情况与病人近期预后有关，均是病人住院28 d内死亡的影响因素，且均对病人28 d内死亡具有一定的预测价值，但各指标联合预测的价值更高。

Predictive value of peripheral blood Th1/Th2 and Treg/Th17 cytokines on the short-term prognosis of patients with severe sepsis

ObjectiveTo investigate the predictive value of peripheral blood Th1/Th2 and Treg/Th17 cytokines on the short-term prognosis of patients with severe sepsis.MethodsA total of 120 patients with severe sepsis admitted to Suzhou Hospital Affiliated to Anhui Medical University from April 2018 to April 2021 were enrolled as the study group, and 103 healthy examination people in the same period were selected as the control group.The levels of peripheral blood Th1/Th2 cytokinesγ-interferon (IFN-γ) and interleukin-4(IL-4)] and Treg/Th17 cytokinestransforming growth factor β (TGF-β) and interleukin-17(IL-17)] were detected and compared.All patients were followed up for 28 days, and they were divided into death group and survival group according to the survival status in the study group.The levels of peripheral blood IFN-γ, IL-4, TGF-β, IL-17, IFN-γ/IL-4 and TGF-β/IL-17 were compared in the death group and the survival group.The multivariate logistic regression analysis method was used to analyze the relationships between the levels of cytokines and the recent death of patients with severe sepsis.In addition, the receiver operating characteristic(ROC) curve was used to analyze the predictive value of levels of peripheral blood IFN-γ, IL-4, TGF-β, IL-17, IFN-γ/IL-4 and TGF-β/IL-17 on the recent death of patients with severe sepsis.ResultsThe levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in the study group were higher than those of the control group(P < 0.01), but the IFN-γ/IL-4 and TGF-β/IL-17 in the study group were lower than those of the control group (P < 0.05).The 28 days mortality rate of patients was 25.00%.The levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in the death group were higher than those of the survival group(P < 0.01), but the IFN-γ/IL-4 and TGF-β/IL-17 in the death group were lower than those of the survival group(P < 0.01).Age Increases, high APACHE-Ⅱ score and SOFA score, and high levels of serum creatinine, IFN-γ, IL-4, TGF-β, IL-1 were the risk factors affecting the recent death of patients (P < 0.05), and decrease of IFN-γ/IL-4 and TGF-β/IL-17 ratio were the protective factor for the recent death of patients(P < 0.05 to P < 0.01).The sensitivity of the levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 in combined prediction the death within 28 days of hospitalization in severe sepsis patients was higher than that of single prediction, and the AUC was higher than that of single prediction(P < 0.01).The sensitivity of IFN-γ/IL-4 combined with TGF-β/IL-17 in predicting of recent death in patients with severe sepsis was higher than that of single prediction, and AUC was higher than that of single prediction(P < 0.01).ConclusionsThe levels of peripheral blood IFN-γ, IL-4, TGF-β and IL-17 of patients with severe sepsis are abnormally increased, but IFN-γ/IL-4 and TGF-β/IL-17 are reduced, and the changes of levels of them are related to the short-term prognosis of patients, which are the influence factors of patients' death within 28 days after hospitalization, and they all have a certain predictive values for patients' death within 28 days, but the combined prediction value of the four indicators is higher.