新型冠状病毒感染者入院时血清降钙素原、白细胞介素-6和白细胞介素-8水平及其在患者预后中的意义OACSTPCD
Serum levels of procalcitonin,interleukin-6 and interleukin-8 in patients with COVID-19 infection at admis-sion and their significance in patient prognosis
目的 分析患者入院时血清降钙素原(PCT)和细胞因子水平对新型冠状病毒感染者(COVID-19)预后的预测价值.方法 纳入 2022年11月至2023年2月首都医科大学附属北京胸科医院收治的确诊COVID-19,采用化学发光法检测血清PCT水平,流式微球阵列法检测血清细胞因子IL-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12p70、IL-17A、IL-17F、IL-22、TNF-α、TNF-β、IFN-γ水平.将入住ICU、接受机械通气和院内死亡定义为预后不良,排除合并细菌感染的患者后,分析入院时血清中PCT和细胞因子水平与COVID-19患者预后的关系.结果 共纳入176例资料完整的患者,其中PCT正常组134例,PCT升高组42例,中位年龄为71.50岁,男性占71.59%.PCT升高组患者ICU入住率(38.41%vs.13.11%,P<0.05)、机械通气率(76.92%vs.24.59%,P<0.001)和院内死亡率(38.46%vs.6.56%,P<0.001)均显著高于PCT正常组.预后不良患者血清中细胞因子 IL-6(7.40 pg/mL vs.4.78 pg/mL,P<0.05)和 IL-8(10.97 pg/mL vs.5.92 pg/mL,P<0.001)的水平显著高于预后良好者.根据ROC曲线计算,PCT、IL-6和IL-8预测COVID-19患者预后不良的曲线下面积分别为0.687、0.660和0.746;灵敏度分别为52.78%、55.17%和72.41%;特异度分别为81.58%、74.19%和74.19%.当PCT、IL-6和IL-8联合预测COVID-19患者预后时,曲线下面积为0.764,灵敏度为70.00%,特异度为80.00%.结论 血清 PCT 和细胞因子 IL-6、IL-8 可作为COVID-19患者预后不良的预测标志物.
Objective To analyze the predictive value of serum levels of procalcitonin(PCT)and cytokines on the prognosis of patients with COVID-19 at admission.Methods From November 2022 to February 2023,patients diagnosed with COVID-19 who were admitted to Beijing Chest Hospital were enrolled.Chemiluminescence was used to detect serum PCT levels,and flow microsphere array was used to detect serum cytokines IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17A,IL-17F,IL-22,TNF-α,TNF-β,IFN-γ level.ICU admission,mechanical ventilation and in-hospital death were defined as poor prognosis.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID-19 patients was analyzed.After excluding patients with bacterial infection,the relationship between serum PCT and cytokine levels at admission and the prognosis of COVID-19 patients was analyzed.Results A total of 176 patients with complete data were included,including 134 in the PCT-normal group and 42 in the PCT-elevated group,with a median age of 71.50 years and 71.59%males.Patients in the PCT elevated-group had significantly higher rates of ICU admission(38.41%vs.13.11%,P<0.05),mechanical ventilation(76.92%vs.24.59%,P<0.001)and in-hospital mortality(38.46%vs.6.56%,P<0.001)were significantly higher than those in the PCT-normal group.Serum levels of cytokines IL-6(7.40 pg/mL vs.4.78 pg/mL,P = 0.033 4)and IL-8(10.97 pg/mL vs.5.92 pg/mL,P<0.001)were significantly higher in patients with poor prognosis than in those with good prognosis.The area under the curve for PCT,IL-6,and IL-8 to predict poor prognosis in COVID-19 patients was 0.687,0.660,and 0.746,respectively;sensitivity was 52.78%,55.17%,and 72.41%,respectively;and specificity was 81.58%,74.19%,and 74.19%,respectively,as calculated from the ROC curve.When PCT,IL-6 and IL-8 jointly predict the prognosis of COVID-19 patients,the area under the curve is 0.764,the sensitivity is 70.00%,and the specificity is 80.00%.Conclusion Serum PCT and cytokines IL-6 and IL-8 could be used as predictive markers for poor prognosis in patients with COVID-19.
龙嗣博;施亦衡;时广利;赵艳;王桂荣;陈燕;张鑫桐;尹颜军;杨丽梅;郑迈克;王潮虹;孙晴;晏君
首都医科大学附属北京胸科医院检验科 北京 101149
临床医学
新型冠状病毒感染细胞因子降钙素原预后
COVID-19 infectioncytokinesprocalcitoninprognosis
《实用医学杂志》 2024 (004)
471-475 / 5
北京市高层次公共卫生技术人才项目(编号:2022-3-040);北京市通州区科技计划项目(编号:KJ2023CX038);北京市通州区"两高"人才工程"领军人才"项目(编号:YH201917)
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