IL-6、TNF-α与APACHEⅡ评分判断ICU老年重症感染病人预后的价值

    Prognostic value of the levels of IL-6 and TNF-α, and APACHE Ⅱ score in elderly patients with severe infection in ICU

    • 摘要:
      目的探讨白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)与急性生理和慢性健康状况(APACHEⅡ)评分判断ICU老年重症感染病人预后的价值。
      方法选择ICU住院的老年脓毒症病人78例,按病情严重程度将病人分为脓毒症组(n=35)、严重脓毒症组(n=24)和脓毒症休克组(n=19);根据预后将病人分为存活组(n=60)和死亡组(n=18)。采用酶联免疫吸附试验检测血清中IL-6和TNF-α的水平,并对病人进行APACHE Ⅱ评分。采用受试者工作特征曲线(ROC)分析法评价各指标对病人预后的价值。
      结果脓毒症组、严重脓毒症组、脓毒症休克组病人IL-6、TNF-α水平和APACHEⅡ评分均依次升高(P < 0.05~P < 0.01)。存活组IL-6和APACHEⅡ评分均明显低于死亡组(P < 0.01),2组TNF-α水平差异无统计学意义(P>0.05)。IL-6、TNF-α和APACHEⅡ评分三者间均呈正相关关系(P < 0.05~P < 0.01)。IL-6、TNF-α和APACHEⅡ评分联合检测的ROC曲线下面积为0.854,高于三者单独检测(P < 0.05)。
      结论IL-6、TNF-α、APACHEⅡ评分均对ICU老年重症感染病人的预后有一定的评估价值,三者联合检测可提高预测价值。

       

      Abstract:
      ObjectiveTo observe the prognostic value of the levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α), and acute physiology and chronic health score(APACHE)Ⅱ score in elderly patients with severe infection in intensive care unit(ICU).
      MethodsSeventy-eight elderly patients were divided into the sepsis group(n=35), severe sepsis group(n=24) and septic shock group(n=19) according to the severity of the disease.According to the prognosis, the patients were divided into the survival group(n=60) and death group(n=18).Receiver operating characteristic (ROC)curve was used to evaluate the prognostic value of each index.
      ResultsThe levels of IL-6 and TNF-α, and APACHEⅡ score of patients in the sepsis group, severe sepsis group and septic shock group gradually increased(P < 0.05 to P < 0.01).The IL-6 level and APACHEⅡ score in survival group were significantly lower than those in death group(P < 0.01), and there was no statistical significance in the TNF-α level between two groups(P>0.05).The levels of IL-6 and TNF-α, and APACHEⅡ score were all positively correlated(P < 0.05 to P < 0.01).The area under the ROC curve of the combined detection of IL-6, TNF-α and APACHE Ⅱ scores was 0.854, which was significantly higher than that of the three alone(0.678, 0.600 and 0.691, respectively) (P < 0.05).
      ConclusionsThe levels of IL-6 and TNF-α, and APACHE Ⅱ score have certain values in evaluating the prognosis of elderly patients with severe infection in ICU, and the combined detection can improve the prognosis value.

       

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