Zhou Hua, Tu Jia-jin, Huang Yi, Chen Xing-guang, Deng Yong-jun
Department of Burns, Ganzhou Municipal Hospital of Jiangxi Province, Ganzhou 341000, China.
Zhonghua Shao Shang Za Zhi. 2012 Apr;28(2):111-5.
To observe the changes in serum contents of interleukin-6 (IL-6) and interleukin-10 (IL-10) in patients with severe burn injury, and to investigate their relation with occurrence of sepsis and prognosis of patients.
One-hundred and sixty adult patients admitted into our hospital (1.0 ± 6.0) h after injury during March 2007 to March 2011 with massive and severe burns were enrolled in the investigation. Patients were divided into non-sepsis group (NS, n = 112), sepsis-survival group (SS, n = 36), and sepsis-deceased group (SD, n = 12) based on the occurrence of sepsis and death. Sepsis occurred on post burn day (PBD) 9 ± 5 in patients in the latter two groups. Patients died on PBD 18 ± 4 in SD group. Twenty healthy adult volunteers were chosen as healthy control group (HC). The age of subjects for observation among four groups, and total burn area and full-thickness burn area of patients among NS, SS, and SD groups were compared. Serum was isolated from blood samples collected from each patient every day from day of admission till PBD 20 to determine the contents of IL-6 and IL-10 by ELISA, and the same determinations were done in HC group. Data of trial subjects were processed with one-way analysis of variance. Data of IL-6 and IL-10 contents were processed with analysis of variance of repeated measure data and SNK method (q test).
(1) There was no significant statistical difference among four groups in age (F = 2.090, P > 0.05). Total burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05), and total burn area of patients in SD group was obviously larger than that in SS group (q test, P < 0.05). Full-thickness burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05). (2) Serum contents of IL-6 of patients in NS, SS, and SD groups from PBD 1 to 20 were obviously higher than that of volunteers in HC group. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 7 (with F value from 0.188 to 2.897, P values all above 0.05). Serum content of IL-6 of patients in NS group decreased from PBD 4. Serum content of IL-6 of patients in SS group decreased gradually from PBD 13, but that in SD group increased continuously at the same time points. Serum contents of IL-6 of patients in NS group [(262 ± 25) pg/mL on PBD 8] were lower than those in SS group [(287 ± 38) pg/mL on PBD 8, q test, P < 0.05] and SD group [(299 ± 22) pg/mL on PBD 8, q test, P < 0.05] from PBD 8. Serum contents of IL-6 of patients in SS group [(300 ± 33) pg/mL on PBD 13] were obviously lower than those in SD group [(338 ± 22) pg/mL on PBD 13, q test, P < 0.05] from PBD 13. (3) Serum contents of IL-10 of patients in NS, SS, and SD groups were higher than that in HC group at each time point. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 5 (with F values from 1.802 to 2.538, P values all above 0.05). Serum content of IL-10 of patients in NS group was obviously lower than that of patients in SD group from PBD 6 (q test, P values all below 0.05). On PBD 8, serum content of IL-10 of patients in SS group [(54 ± 19) pg/mL] was obviously lower than that in SD group [(91 ± 23) pg/mL, q test, P < 0.05]. The sum of sensitivity (83.33%, 10/12) and specificity (91.67%, 33/36) minus 1 was maximum when the critical value of IL-10 content was set at 77 pg/mL based on the comparison between SS group and SD group in serum content of IL-10 on PBD 8.
The occurrence and outcome of sepsis is related to burn area and depth when the patients are in similar age. Serum contents of IL-6 and IL-10 play important roles in the pathogenesis of sepsis after burn. IL-6 content in early stage shall not be used in predicting the prognosis of patients with sepsis. IL-10 continuously higher than 77 pg/mL in early stage forecasts unfavorable prognosis of patient.
观察重度烧伤患者血清白细胞介素-6（IL-6）和白细胞介素-10（IL-10）含量的变化，探讨其与脓毒症发生及患者预后的关系。
选取2007年3月至2011年3月期间我院收治的160例成年重度烧伤患者，于伤后（1.0±6.0）h入院。根据是否发生脓毒症及死亡情况将患者分为非脓毒症组（NS，n = 112）、脓毒症存活组（SS，n = 36）和脓毒症死亡组（SD，n = 12）。后两组患者脓毒症发生于伤后第9±5天。SD组患者于伤后第18±4天死亡。选取20名健康成年志愿者作为健康对照组（HC）。比较四组观察对象的年龄，以及NS、SS和SD组患者的烧伤总面积和Ⅲ度烧伤面积。从入院当天至伤后第20天，每天采集每位患者的血样分离血清，采用酶联免疫吸附测定法（ELISA）测定IL-6和IL-10含量，HC组也进行同样的测定。对试验对象的数据进行单因素方差分析。IL-6和IL-10含量数据采用重复测量数据的方差分析和SNK法（q检验）处理。
（1）四组患者年龄差异无统计学意义（F = 2.090，P＞0.05）。SS组和SD组患者的烧伤总面积显著大于NS组（q检验，P值均＜0.05），且SD组患者的烧伤总面积明显大于SS组（q检验，P＜0.05）。SS组和SD组患者的Ⅲ度烧伤面积显著大于NS组（q检验，P值均＜0.05）。（2）NS、SS和SD组患者伤后第1天至第20天血清IL-6含量明显高于HC组志愿者。伤后第1天至第7天，NS、SS和SD组患者血清IL-6含量差异无统计学意义（F值为0.188至2.897，P值均＞0.05）。NS组患者血清IL-6含量自伤后第4天开始下降。SS组患者血清IL-6含量自伤后第13天逐渐下降，但SD组患者在相同时间点持续升高。伤后第8天起，NS组患者血清IL-6含量[伤后第8天为（262±25）pg/mL]低于SS组[伤后第8天为（287±38）pg/mL，q检验，P＜0.05]和SD组[伤后第8天为（299±22）pg/mL，q检验，P＜0.05]。伤后第13天起，SS组患者血清IL-6含量[伤后第13天为（300±33）pg/mL]明显低于SD组[伤后第13天为（338±22）pg/mL，q检验，P＜0.05]。（3）NS、SS和SD组患者各时间点血清IL-10含量均高于HC组。伤后第1天至第5天，NS、SS和SD组患者血清IL-6含量差异无统计学意义（F值为1.802至2.538，P值均＞0.05）。伤后第6天起，NS组患者血清IL-10含量明显低于SD组患者（q检验，P值均＜0.05）。伤后第8天，SS组患者血清IL-10含量[（54±19）pg/mL]明显低于SD组[（91±23）pg/mL，q检验，P＜0.05]。根据伤后第8天SS组和SD组患者血清IL-10含量比较，当IL-10含量临界值设定为77 pg/mL时，敏感度（83.33%，10/12）与特异度（91.67%，33/36）之和减1最大。
在年龄相近的患者中，脓毒症的发生及转归与烧伤面积和深度有关。血清IL-6和IL-10含量在烧伤后脓毒症的发病机制中起重要作用。早期IL-6含量不宜用于预测脓毒症患者的预后。早期IL-10持续高于77 pg/mL预示患者预后不良。
Zotero 插件