作者：孟青山，谭营帅，王柳，池颖颖，邢丽华

单位：

450052河南省郑州市，郑州大学第一附属医院呼吸重症监护病房

Units：

Respiratory Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

关键词：

呼吸窘迫综合征；白介素6；白介素10；乳酸；预后

Keywords：

Respiratory distress syndrome; Interleukin-6; Interleukin-10; Lactic acid; Prognosis

CLC：

R 563.8

DOI：

10.12114/j.issn.1008-5971.2023.00.332

Funds：

国家自然科学基金资助项目（82074212）；河南省科技攻关计划项目（222102310148）

摘要：

目的　探讨白介素6（IL-6）/白介素10（IL-10）比值联合乳酸对急性呼吸窘迫综合征（ARDS）患者 预后的预测价值。方法　选取2020年6月—2023年4月郑州大学第一附属医院呼吸重症监护病房（RICU）收治的ARDS患 者130例，收集患者一般资料及实验室检查指标。根据患者入住RICU后28 d预后情况将其分为好转组（50例）和恶化组 （80例）。采用多因素Logistic回归分析探讨ARDS患者预后的影响因素；采用ROC曲线分析IL-6/IL-10比值、乳酸及二 者联合对ARDS患者预后的预测价值。结果　两组急性生理与慢性健康评价系统Ⅱ（ APACHE Ⅱ）评分、中性粒细胞与 淋巴细胞比值（NLR）、白蛋白、C反应蛋白（CRP）、CD8 + T淋巴细胞计数、CD4 + /CD 8 + T淋巴细胞比值、 IL-6、IL-10、 IL-6/IL-10比值、乳酸比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，APACHEⅡ评分、 IL-6/IL-10比值、乳酸是ARDS患者预后的独立影响因素（P＜0.05）。ROC曲线分析结果显示，IL-6/IL-10比值、乳酸及 二者联合预测ARDS患者预后恶化的曲线下面积分别为0.783、0.791、0.855，二者联合预测ARDS患者预后恶化的曲线下 面积分别大于IL-6/IL-10比值、乳酸单独预测ARDS患者预后恶化的曲线下面积（P＜0.05）。结论　APACHEⅡ评分、 IL-6/IL-10比值、乳酸是ARDS患者预后的独立影响因素，IL-6/IL-10比值联合乳酸对ARDS患者预后有一定预测价值。

Abstract：

　Objective To explore the predictive value of interleukin-6 (IL-6) /interleukin-10 (IL-10) ratio combined with lactic acid for the prognosis of patients with acute respiratory distress syndrome (ARDS) . Methods A total of 130 patients with ARDS admitted to the Respiratory Intensive Care Unit (RICU) in the First Affiliated Hospital of Zhengzhou University from June 2021 to April 2023 were selected. The general data and laboratory examination indicators of the patients were collected, and the patients were divided into improvement group (n=50) and deterioration group (n=80) according to the 28-day prognosis after admission to the RICU. Multivariate Logistic regression analysis was used to explore the influencing factors of the prognosis of patients with ARDS. The ROC curve was used to explore the predictive value of the IL-6/IL-10 ratio, lactic acid and their combination for the prognosis of patients with ARDS. Results There were significant differences in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, neutrophil to lymphocyte ratio (NLR) , albumin, C-reactive protein (CRP) , CD 8 + T-lymphocyte count, CD4 + /CD8 + T-lymphocyte ratio, IL-6, IL-10, IL-6/IL-10 ratio, lactic acid between the two groups ( P < 0.05) . Multivariate Logistic regression analysis showed that APACHEⅡ score, IL-6/IL-10 ratio, lactic acid were the influencing factors of the prognosis of patients with ARDS (P < 0.05) . ROC curve analysis showed that the AUC of the IL-6/IL-10 ratio, lactic acid and their combination in predicting the deterioration of prognosis of patients with ARDS was 0.783, 0.791, 0.855, respectively. The AUC of their combination in predicting the deterioration of prognosis of patients with ARDS was greater than that of IL-6/IL-10 ratio, lactic acid alone (P < 0.05) . Conclusion APACHEⅡ score, IL-6/IL-10 ratio, lactic acid are the influencing factors of the prognosis of patients with ARDS. IL-6/IL-10 ratio combined with lactic acid have certain predictive value for the prognosis of patients with ARDS.

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