| Objective: Sepsis and its multiple organ dysfunction syndrome(MODS)are the leading causes of death in ICU patients.Changes in inflammatory mediators are closely related to the severity and prognosis of patients with sepsis.Interleukin-1β(IL-1β),interleukin-2R(IL-2R),interleukin-6(IL-6),interle ukin-8(IL-8),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and so on are multi-biological function of proinflammatory / antiinflammatory cytokines,is involved in infection caused by systemic inflammatory response Syndrome(SIRS)important inflammatory mediators,can provide an important basis for clinical diagnosis and prognosis.The aim of this study was to investigate the relationship between the changes of cytokine concentration and the severity and prognosis of sepsis by detecting the dynamic changes of serum proinflammatory and antiinflammatory cytokines in ICU patients,and to explore the relationship between mild sepsis and severe sepsis Disease patients with immune status changes in the characteristics and laws of the diagnosis of sepsis and determine the prognosis of patients with sepsis,improve the survival rate of patients is of great significance.Methods: Collected in October 2014-December 2016 in The First Affiliated Hospital of the Hebei North University,212 patients diagnosed with sepsis in ICU,Development criteria: age <18 years old patients,pregnant women and lactating patients,patients with acute myocardial infarction,patients with severe liver disease,cancer,autoimmune disease in patients with history,and taking may affect serum IL-1β,IL-2R,IL-6,IL-8,IL-10 and TNF-α levels of patients,as well as patients who are discharged automatically.Eventually included 189 cases.Including 121 males and 68 females,the average age of 66.6 ± 15.47;Divided into ABC three groups,A group of control group for admission to ICU but not suffering from sepsis in patients with serum samples of 50 cases,B group of mild sepsis group of 125 cases,group C severe sepsis group of 64 cases,Sexual research.APECH-Ⅱscore was collected from all patients within 24 hours after ICU was collected.Routine infection markers were examined at 1,3,7D.The IMMUNIT1000 instrument of SIEMENS was used to measure the cytokine IL 1β,IL-2,IL-6,IL-8,IL-10,TNF-α serum concentrations;PCT using Germany,CBRTHOLD detector,using double antibody sandwich immunochromatography;CRP using Orion Diagnostica in Finland detector.Sepsis diagnosis based on the 2012 International Guidelines for the Treatment of Sepsis;Severe Septic Diagnostic Criteria are based on sepsis due to organ dysfunction;septic shock is severe sepsis after giving sufficient fluid recovery Accompanied by unresponsive persistent hypotension.Statistical analysis: SPSS19.0 software was used for statistical analysis.The positive data of IL-1β,IL-2R,IL-6,IL-8,IL-10 and TNF-α serum were measured.The data are described by the mean ± standard deviation(?X±s),and the non-normal distribution data is described by median and quartile spacing.The relationship between age and prognosis was analyzed by two independent samples.The count data were described as percentages.The relationship between sex and prognosis was analyzed by chi-square test.The variance homogeneity test was performed in the control group,the sepsis group and the severe sepsis group.The variance analysis and the Kruskal-Wallis H nonparametric test were used to compare the multiple samples.All tests were bilateral,P<0.05 for the difference was statistically significant.Results:1 There were significant differences in mortality between the control group,the sepsis group and the severe sepsis group,and the mortality rate in the sepsis group was significantly higher than that in the sepsis group(P<0.05).Serious sepsis patients with abdominal infection rate was higher than sepsis patients(P<0.05),suggesting that patients with abdominal infection are more likely to progress to severe sepsis.The positive rate of humoral culture in severe sepsis group was significantly higher than that in sepsis group(P<0.05).The APACHE II score of patients with severe sepsis was significantly higher than that of the control group and sepsis group(P<0.01).The indexes of conventional inflammation syndromes were significantly higher in the sepsis group and severe sepsis group,And PCT level were higher than the control group,the difference was statistically significant(P<0.01).2 The levels of IL-1β,IL-2R,IL-6,IL-8,IL-10,TNF-α and APACHE II in the control group,sepsis group and severe sepsis group were significant Differences(P<0.05).Comparison between the two groups found,The levels of IL-2R,IL-8,IL-10 and TNF-α in the sepsis group were significantly higher than those in the control group(P<0.05).There was no significant difference between the two groups in APACHEII score.The levels of IL-2R,IL-6,IL-8,IL-10 and TNF-α in severe sepsis were significantly higher than those in the control group(P<0.05).Sepsis group and severe sepsis group were analyzed and compared between the two groups found that all levels of cytokine levels were significantly different(P<0.01).3 The study found,The levels of IL-2R,IL-8,IL-10 and APACHE II in the death group were significantly higher than those in the survivors(P<0.05),but There was no significant difference in TNF-α,IL-1β and IL-6 concentrations(P>0.05).4 The concentration of cytokines in patients with the progress of treatment has a dynamic change.There was a significant change in cytokine IL-6 between 1,3 and 7days,but there was no significant difference between day 1 and day 3(P>0.05).There was a significant difference between the first day and the 7th day and the 3rd day and the 7th day(P<0.05).Suggesting that with the progress of treatment and the improvement of the disease,IL-6 gradually decreased.IL-2R,IL-8,IL-10,TNF-α and APACHE II showed an increasing trend on the third day,With the improvement of the condition,it gradually decreased on the 7th day,But there was no significant difference in the concentration level(P>0.05).Conclusion:1 All levels of cytokines in patients with severe sepsis were higher than those with mild sepsis and non sepsis.Increased concentrations of cytokines can help diagnose sepsis and determine the severity of the condition.2 IL-2R,IL-8,IL-10 and TNF-α in patients with mild sepsis were higher than those with non-sepsis;IL-2R,IL-6,IL-8,IL-10 and TNF-α in patients with severe sepsis are higher than those with non-sepsis,IL-1β,IL-2R,IL-6,IL-8,IL-10 and TNF-α in patients with severe sepsis are higher than those with mild sepsis and non-sepsis,Suggesting that the more elevated cytokines,the higher the level of elevated cytokines,the worse the prognosis.3 The levels of IL-2R,IL-8 and IL-10 in the death group were significantly higher than those in the survivors group.These cytokines were more effective in judging the prognosis.4 IL-6 concentration was associated with ICU time,This study shows that IL-6 levels do not change at 1D,3D.There is a big difference in 1D,3D comparison 3D,7D,Suggesting that IL-6 did not change significantly within 72 hours,with the progress of treatment,the disease began to improve IL-6 gradually decreased,can be used to determine the treatment effect,suggesting prognosis. |
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