白细胞介素-31 与炎症小体的相互作用：一种有前途的诊断和预后标志物，用于早期识别危重症患者的脓毒症。

Interleukin-31 interaction with inflammasome: A promising diagnostic and prognostic panel for early sepsis identification in critically ill patients.

机构信息

Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Anesthesia and Critical Care Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Cytokine. 2020 Jul;131:155102. doi: 10.1016/j.cyto.2020.155102. Epub 2020 Apr 16.

DOI:10.1016/j.cyto.2020.155102

PMID:32305780

Abstract

PURPOSE

This case-control study aimed to evaluate the ability to use a panel of IL-31, IL-1ß and NLRP3 to differentiate sepsis from systemic inflammatory response syndrome (SIRS) and to predict septic shock.

METHODS

Serum levels of IL-31, IL-1ß and NLRP3 were measured by ELISA in 149 participants; 38 with sepsis, 51 with SIRS, 30 with septic shock and 30 healthy controls.

RESULTS

Lower levels of IL-31 were found in sepsis (10.21 ± 4.34 pg/ml) compared to SIRS (16.74 ± 3.18 pg/ml) and to controls with the lowest levels detected in septic shock (6.26 ± 2.72 pg/ml). IL-1ß and NLRP3 levels were higher in sepsis (54.99 ± 14.11 pg/ml and 9.93 ± 2.38 ng/ml) compared to SIRS (27.8 ± 6.94 pg/ml and 4.86 ± 1.33 ng/ml) with the highest levels seen in septic shock (125.1 ± 32.79 pg/ml and 19.43 ± 6.48 ng/ml) respectively. IL-31 discriminated sepsis in patients showing SIRS with 80% sensitivity and 70% specificity and, identified septic shock with 78.6% sensitivity and 60.3% specificity. IL-1ß identified sepsis from SIRS with 93.3% and 83.3% specificity. NLRP3 discriminated sepsis from SIRS with 94.5% sensitivity and 93.3% specificity. And, with sensitivity 99.1% and 90.1% and specificity 98.9% and 80% IL-1ß and NLRP3 could respectively define septic shock. A panel of combined markers provided 100% sensitivity and specificity. The three biomarkers proved to be independent prognostic biomarkers. At 95% CI, IL-31 hazard ratio (HR) was 0.716, p = 0.001; IL-1β HR was 1.023, p ≤ 0.001; and NLRP3 HR was 1.114, p ≤ 0.001. Additionally, IL-1ß proved to be an independent predictor of septic shock (β = 0.355; p = 0.035).

CONCLUSION

The cross-relation between IL-31, IL-1ß and NLRP3 in sepsis can provide a promising diagnostic and prognostic panel.

摘要

目的

本病例对照研究旨在评估使用 IL-31、IL-1β 和 NLRP3 联合检测区分脓毒症与全身炎症反应综合征（SIRS）并预测感染性休克的能力。

方法

通过 ELISA 检测 149 名参与者的血清 IL-31、IL-1β 和 NLRP3 水平，其中 38 名脓毒症患者、51 名 SIRS 患者、30 名感染性休克患者和 30 名健康对照者。

结果

与 SIRS（16.74±3.18pg/ml）和对照组（6.26±2.72pg/ml）相比，脓毒症患者血清中 IL-31 水平更低（10.21±4.34pg/ml），而 IL-1β 和 NLRP3 水平则更高（54.99±14.11pg/ml 和 9.93±2.38ng/ml）。与 SIRS（27.8±6.94pg/ml 和 4.86±1.33ng/ml）相比，感染性休克患者血清中 IL-31、IL-1β 和 NLRP3 水平更高（分别为 125.1±32.79pg/ml 和 19.43±6.48ng/ml）。IL-31 对 SIRS 患者脓毒症的敏感性为 80%，特异性为 70%，对感染性休克的敏感性为 78.6%，特异性为 60.3%。IL-1β 对 SIRS 患者脓毒症的特异性为 93.3%，敏感性为 83.3%。NLRP3 对 SIRS 患者脓毒症的敏感性为 94.5%，特异性为 93.3%。IL-1β 和 NLRP3 分别对感染性休克的敏感性为 99.1%和 90.1%，特异性为 98.9%和 80%，可以分别定义感染性休克。联合标志物组的敏感性和特异性均为 100%。三个生物标志物均为独立的预后生物标志物。在 95%CI 中，IL-31 风险比（HR）为 0.716，p=0.001；IL-1β HR 为 1.023，p≤0.001；NLRP3 HR 为 1.114，p≤0.001。此外，IL-1β 被证明是感染性休克的独立预测因子（β=0.355，p=0.035）。