关键词: 脓毒症, 预后, 白细胞介素6, 白细胞介素18

Abstract: Objective  To explore the expression of peripheral blood immune factors in patients with severe sepsis and its value in predicting the prognosis of patients. Methods  The immune factors of 90 patients with severe sepsis who were diagnosed and treated in our hospital from June 2015 to December 2017 were divided into survival group (65 cases) and death group (25 cases) according to the prognosis. The clinical data, APACHEⅡ, SOFA, procalcitonin(PCT) serological indexes and the expression of peripheral blood immune factors (such as interleukin6,  interleukin10,  interleukin18,  tumor necrosis factorα  and transforming growth factorβ1) were compared between the two groups. And the receiver operating characteristic curve was applied to the effectiveness evaluation  of the above three factors in predicting the prognosis of the patients.Results  The APACHE Ⅱ score,  SOFA score,  PCT and IL18 of death group were significantly higher than those of  the survival group (P<0.05). Pearson correlation analysis showed that IL6 and IL18 were significantly correlated with APACHE Ⅱ score (r=0.679,  0.651),  SOFA score (r=0.643,  0.630) and PCT (r=0.711, 0.678). The ROC curve showed that the area under the curve(AUC) for predicting prognosis of  the patients using IL6 and IL18 (AUC=0.841,  0.802) were higher,  followed by PCT and APACHEⅡ scores (AUC=0.710 and 0.685), and the SOFA score was relatively lower (AUC=0.648). The combined diagnosis of IL6 and IL18 significantly improved the diagnostic efficiency (AUC=0.909). The sensitivity and negative predictive value of IL6 and IL18 in prognosis of patients with severe sepsis were significantly higher than those of SOFA,  APACHEⅡ score and PCT (P<0.05). Conclusion  There is obvious anomaly in the expression of peripheral blood immune factors in the patients.  The IL6 and IL18 have high diagnostic efficacy in predicting the death of patients with severe sepsis.

Key words: sepsis, prognosis, interleukin6, interleukin18