老年脓毒症患者早期炎症因子水平及预后的相关性分析
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南京医科大学第一附属医院

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血清细胞因子检测在ICU老年重症感染中的诊断意义及预后判断价值


Correlation analysis of early inflammatory factors and prognosis in elderly patients with sepsis
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First Affiliated Hospital, Nanjing Medical University

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Diagnostic significance and prognostic value of serum cytokine detection in elderly patients with severe infection in ICU

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    摘要:

    目的 分析老年脓毒症患者早期WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym与病情严重程度及预后的相关性。方法 回顾性分析江苏省人民医院2020年9月至2022年3月入住老年ICU 135名脓毒症患者的临床资料,根据年龄将患者分为老年组(≥65岁)和青壮年组(<65岁);将老年脓毒症患者根据是否为脓毒症休克分为脓毒症休克组与脓毒症组、根据28天病死率分为存活组及死亡组。以上分组两两比较WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym、APACHE II评分;用Sperman相关分析法分析老年脓毒症患者WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym与APACHE II评分的相关性;绘制ROC曲线比较老年脓毒症患者WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym、APACHE II评分对28d病死率的判断。结果 脓毒症患者中老年组PLT、Lym显著低于青壮年组,APACHE II评分显著高于青壮年组。老年脓毒症患者中,脓毒症休克组PCT、CRP、APACHE II评分显著高于脓毒症组,PLT显著低于脓毒症组;存活组APACHE II评分显著低于死亡组;老年脓毒症患者IL-10与APACHE Ⅱ评分呈正相关, PLT与APACHE Ⅱ评分呈负相关;根据ROC曲线及曲线下面积,单个指标APACHE II评分、所有指标除了APACHE II评分联合以及所有指标联合均能预测老年脓毒症患者28d病死率。结论 在老年脓毒症患者中,早期血浆PLT越低、IL-10越高,老年脓毒症患者病情越重,预后越差;多种指标联合预测老年脓毒症患者28d病死率准确率更高。

    Abstract:

    Objective To analyse the correlation of between early WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym and severity and prognosis in elderly patients with sepsis. Methods Retrospective analysis of the clinical data of 135 sepsis patients admitted to the Geriatric ICU in Jiangsu Province Hospital from September 2020 to March 2022. According to age, patients were divided into the elderly group (≥ 65 years old) and the young adult group (<65 years old); The elderly patients with sepsis were divided into septic shock group and septic group according to whether they were septic shock, and into survival group and death group according to the 28-day mortality rate. The above groups compare WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym、APACHE II score in pairs. To analyse the correlations between WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym and APACHE II score in elderly patients with sepsis by Sperman correlation analysis. Through drawing ROC curve to compare WBC、PCT、CRP、IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ、PLT、Lym and APACHE II score in the judgement of 28-day mortality rate in elderly patients with sepsis. Results In patients with sepsis, the PLT、Lym in the elderly group were significantly lower than those in the young adult group, and APACHE II score in the elderly group was significantly higher than that in the young adult group. In elderly patients with sepsis, the PCT、CRP、APACHE II score in septic shock group were significantly higher than those in the septic group, and PLT in septic shock group was significantly lower than that in the septic group; and APACHE II score in the survival group was significantly lower than that in the death group; IL-10 is positively correlated with APACHE Ⅱ score, and PLT is negatively correlated with APACHE Ⅱ score. According to ROC curve and area under the curve, the APACHE II score of a single indicator, combination of all indicators except APACHE II score and the combination of all indicators can predict the 28-day mortality rate of elderly patients with sepsis. Conclusion In elderly patients with sepsis, the lower the PLT and the higher IL-10 in the early stage, the worse the condition and prognosis of the elderly patients with sepsis. Combination of multiple indicators to predict 28-day mortality in elderly patients with sepsis has a higher accuracy.

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  • 收稿日期:2023-02-21
  • 最后修改日期:2023-03-28
  • 录用日期:2023-08-29
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