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目的:探讨白细胞介素-27(Interleukin 27,IL-27)对成人全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)和脓毒症的诊断价值。方法:214例SIRS患者按入院诊断结果及感染源不同分为非脓毒症组(n=80)、肺源性脓毒症组(n=73)和非肺源性脓毒症组(n=61)。采用酶联免疫吸附试验(ELISA)检测各组患者血清IL-27和降钙素原(PCT)水平;绘制受试者工作特征曲线(ROC),判断各指标的诊断价值,分析各生物标志物的性能,判断潜在的预测变量。结果:肺源性脓毒症患者体温符合SIRS标准的比例为65.8%,明显高于非脓毒症患者(45.0%)及非肺源性脓毒症患者(45.9%)(P<0.05);非肺源性脓毒症患者白细胞数符合SIRS标准的比例为68.9%,明显高于非脓毒症患者42.5%,(P<0.05)。确诊脓毒症后的患者血清IL-27的AUC为0.655,PCT的AUC为0.649。根据不同感染源进一步分析,肺源性和非肺源性脓毒症患者血清IL-27水平明显高于非脓毒症患者,肺源性和非肺源性脓毒症患者PCT水平明显高于非脓毒症患者(P<0.01)。ROC曲线分析发现,肺源性和非肺源性脓毒症患者血清IL-27的AUC分别为0.657和0.652,肺源性和非肺源性脓毒症患者PCT的AUC为0.667和0.629。分别联合检测三组患者的血清IL-27和PCT值,肺源性脓毒症患者的AUC为0.728,非肺源性脓毒症患者的AUC为0.703。对肺源性脓毒症患者与非肺源性脓毒症患者诊断的准确性均有所提升。结论:肺源性和非肺源性脓毒症患者较非脓毒症患者更加符合SIRS标准。IL-27作为脓毒症诊断的生物标志物,对病情变化的反应不敏感,而IL-27和PCT结合可以使诊断的准确性提高。
Objective: To investigate the diagnostic value of Interleukin 27 (IL-27) in adult systemic inflammatory response syndrome (SIRS) and sepsis. Methods: Totally 214 SIRS patients were divided into non-sepsis group (n = 80), pulmonary-derived sepsis group (n = 73) and non-pulmonary sepsis group = 61). Serum levels of IL-27 and procalcitonin (PCT) were measured by enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic curve (ROC) was plotted to determine the diagnostic value of each index. The biomarkers The performance, to determine the potential predictors. Results: The body temperature of patients with pulmonary sepsis was 65.8%, which was significantly higher than that of non - sepsis patients (45.0%) and non - pulmonary sepsis patients (45.9%) (P <0.05). The number of white blood cells in non-pulmonary sepsis patients meeting the SIRS criteria was 68.9%, significantly higher than those in non-sepsis patients (42.5%, P <0.05). The serum AUC of serum IL-27 after the diagnosis of sepsis was 0.655, and the AUC of PCT was 0.649. According to further analysis of different sources of infection, serum IL-27 levels in patients with pulmonary and non-pulmonary sepsis were significantly higher than those without sepsis, PCT levels were significantly higher in patients with pulmonary and non-pulmonary sepsis Non-sepsis patients (P <0.01). ROC curve analysis found that the serum AUC of serum IL-27 in patients with and without pulmonary sepsis was 0.657 and 0.652, respectively. The AUC of PCT in patients with pulmonary and non-pulmonary sepsis was 0.667 and 0.629, respectively. The serum IL-27 and PCT values of the three groups were tested separately. The AUC of patients with pulmonary sepsis was 0.728 and the AUC of patients with non-pulmonary sepsis was 0.703. The diagnostic accuracy of patients with both pulmonary sepsis and non-pulmonary sepsis have improved. Conclusion: Patients with both pulmonary and non-pulmonary sepsis are more SIRS-compliant than non-sepsis patients. As a biomarker for the diagnosis of sepsis, IL-27 is not sensitive to changes in the disease, and the combination of IL-27 and PCT can improve the diagnostic accuracy.