白细胞介素-33在不同严重程度脓毒症中的变化

Changes of interleukin 33 level in sepsis of different severity

摘要:

目的  分析血浆白细胞介素-33（IL-33）在不同严重程度脓毒症中的变化。方法  选取2012年1月-
2015年4月该院重症加强治疗病房（ICU）收治的120例脓毒症患者为研究对象。根据器官功能、感染严重程度将患者分为一般脓毒症组（36例）、严重脓毒症组（36例）和感染性休克组（48例），并选取同期在该院行健康检查的120例志愿者作为对照组。比较患者ICU各时间的APACHE Ⅱ评分、降钙素原（PCT）、白细胞介素-33（IL-33）、白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）和可溶性人基质裂解素2（sST2）的变化；比较患者ICU住院时间和机械通气时间；比较不同预后脓毒症患者ICU各时间的IL-33水平变化。结果  脓毒症患者的APACHE Ⅱ评分、PCT和IL-33水平高于对照组，且脓毒症患者的APACHE Ⅱ评分、PCT和IL-33水平随患者病情加重而升高，差异有统计学意义（P <0.05）。脓毒症患者的ICU住院和机械通气时间随患者病情加重而延长，且感染性休克组的死亡率显著高于其余两组，差异有统计学意义（P <0.05）。脓毒症患者的APACHE Ⅱ评分，PCT、IL-33、IL-6、IL-1β、TNF-α、sST2水平与对照组比较，差异有统计学意义（P <0.05）。脓毒症患者的APACHE Ⅱ评分，PCT、IL-33、IL-6水平随ICU住院时间延长而降低，差异有统计学意义（P <0.05）。脓毒症患者的IL-1β、TNF-α、sST2水平随ICU住院时间延长，变化不明显（P >0.05）。入ICU 30 d后有9例患者死亡为死亡组，111例患者存活为存活组。死亡组患者的IL-33水平随ICU住院时间延长而上升，但差异无统计学意义（P >0.05）。存活组患者的IL-33水平随ICU住院时间延长而下降，死亡组患者入ICU 3 h内IL-33水平较存活组低，入ICU 24 h和5 d时IL-33水平高于存活组，差异有统计学意义（P <
0.05）。结论  脓毒症患者入ICU时血浆IL-33水平升高，而后随ICU住院时间延长而降低，且随患者病情加重而升高，因此血浆IL-33水平能提示患者的预后。

关键词:

白细胞介素-33;重症加强治疗病房;脓毒症

Abstract:

Objective To analyze the plasma interleukin 33 (IL-33) changes in sepsis of different severity. Methods A total of 120 sepsis patients who were admitted to the Intensive Care Unit (ICU) in our hospital  from January 2012 to April 2015 were selected. According to organ function of the patients and the severity of infection they were divided into general sepsis group (36 cases), severe sepsis group (36 cases) and septic shock group (48 cases). And 120 volunteers for health check during the same period were selected as control group. APACHE Ⅱ score, procalcitonin (PCT), IL-33, IL-6, IL-1β, changes in tumor necrosis factor-α (TNF-α) and sST2 of the patients were compared at different time in the ICU. The duration of ICU stay and mechanical ventilation in the ICU were compared between the sepsis groups. The changes of IL-33 levels were compared between the sepsis patients with different prognosis at different time. Results APACHE Ⅱ score, PCT and IL-33 levels in the sepsis groups were higher than those in the control group; and APACHE Ⅱ score, PCT and IL-33 levels in the sepsis patients increased with the increase in the severity of the disease, the difference was statistically significant (P < 0.05). The duration of ICU stay and mechanical ventilation in the sepsis patients prolonged as the disease worsened, and mortality of the septic shock group was significantly higher than that of other two groups (P < 0.05). APACHE Ⅱ score, PCT, IL-33, IL-6, IL-1β, TNF-α and sST2 levels in the sepsis groups were significantly different from those in the control group (P < 0.05). APACHE Ⅱ score, PCT, IL-33 and IL-6 levels in the sepsis patients decreased as the duration of ICU prolonged, the differences were statistically significant (P < 0.05). IL-1β, TNF-α and sST2 levels in the sepsis patients did not have significant changes as the duration of ICU stay prolonged (P > 0.05). Nine patients who died 30 d after hospitalization in the ICU were enrolled into the death group, and the remaining 111 survival patients into the survival group. IL-33 level of the death group rose as the ICU time prolonged, but the difference was not statistically significant (P > 0.05). IL-33 level in the survival group decreased as the duration of ICU stay prolonged. IL-33 level in the death group was lower than that in the survival group within 3 h in the ICU, but significantly higher than that in the survival group at 24 h and on the 5th day in the ICU (P < 0.05). Conclusions In patients with sepsis, plasma IL-33 level increases at the time of entering into ICU, but reduces as the duration of ICU stay prolongs, and elevates as the patients' situation worsens. Therefore, plasma IL-33 level can be a prognostic predictor for sepsis patients.

Key words:

 ;interleukin 33; duration of ICU stay; sepsis