IL-27 和PCT 联合检测在不同分型的脓毒症危重患者中的诊断价值

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。

Value of Combination Detection of Interleukin-27 and Procalcitonin as a Sepsis Diagnostic Biomarker in Critically Ill Adults

Objective:To evaluate interleukin-27 (IL-27) as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome (SIRS) and sepsis.Methods:A total of 214 SIRS patients in department of critical care medicine in our hospital were enrolled. The patients were divided into no sepsis group (n=80), pulmonary original sepsis group (n=73), and non-pulmonary original sepsis group (n=61). Plasma IL-27 and procalcitonin (PCT) were determined with enzyme linked immunosorbent assay (ELISA). Receiver operating characteristic curve (ROC) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance.Results:The body temperature of patients with pulmonary sepsis was in accordance with the SIRS standard of 65.8%, significantly higher than patients with non sepsis (45%) and non pulmonary origin sepsis (45.9%), (P<0.05); the ratio of white blood cell count comply with SIRS standards was 68.9%, was significantly higher than the non sepsis patients 42.5%(P<0.05). The AUC of IL-27 was 0.655 and AUC was 0.649 in the patients with sepsis. According to different source of infection, Serum IL-27 levels were significantly higher in patients with pulmonary and non pulmonary sepsis than in non sepsis patients, the level of PCT in patients with pulmonary and non pulmonary sepsis was significantly higher than those in non sepsis patients(P<0.01). ROC curve analysis, the AUC of IL-27 in the serum of patients with pulmonary and non pulmonary sepsis was 0.657 and 0.652, AUC of PCT was 0.667 and 0.629 in patients with pulmonary and non pulmonary origin. Combined detection of serum IL-27 and PCT in three groups of patients, respectively, AUC of patients with pulmonary origin sepsis was 0.728, AUC was 0.703 in patients with non pulmonary sepsis. The accuracy of the diagnosis of pulmonary sepsis and non pulmonary sepsis patients were improved.Conclusion:Patients with lung and non pulmonary origin sepsis were more in line with SIRS standards than those with non sepsis patients. IL-27 as a biomarker for the diagnosis of sepsis, was not sensitive to the changes of the disease. The combination of PCT and IL-27 can improve the accuracy of diagnosis.