HBP、IL-18联合IL-6对脓毒症病情严重程度及预后的预测价值

汤亚杰; 王湛元; 宋黎洁; 陆国玉; 刘成; 陶言言

doi:10.16766/j.cnki.issn.1674-4152.004077

HBP、IL-18联合IL-6对脓毒症病情严重程度及预后的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.004077

1.
蚌埠医科大学第一附属医院急诊内科，安徽蚌埠 233004
2.
蚌埠医科大学第一附属医院重症医学科

基金项目:

安徽省高校自然科学研究重点项目 2023AH051996

蚌埠医学院自然科学重点项目 2021byzd157

蚌埠医学院科技项目自然科学类重点项目 2022byzd039

详细信息

通讯作者:
陶言言，E-mail: taoyanyan1981@163.com

中图分类号: R631
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出版历程
- 收稿日期: 2024-12-29
- 网络出版日期: 2025-10-25

Predictive value of HBP, IL-18 combined with IL-6 for disease severity and prognosis in sepsis

1.
Emergency Medicine, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的脓毒症病死率高，发展迅速，为评估脓毒症患者的预后及病情分级，本研究通过分析肝素结合蛋白(HBP)、白介素-6(IL-6)及白介素-18(IL-18)的表达水平，探讨这些指标对脓毒症患者的预测价值。方法选取2023年1月—2024年6月蚌埠医科大学第一附属医院急诊医学科和ICU收治的80例患者。根据脓毒症诊断标准，将患者分为非脓毒症组即普通感染组20例、脓毒症组35例、脓毒症休克组25例；比较3组患者HBP、IL-18、IL-6水平；以28 d为研究终点，将脓毒症患者分为生存组和死亡组，比较2组HBP、IL-18、IL-6水平；采用Pearson分析研究HBP、IL-18、IL-6与急性生理与慢性健康状况Ⅱ评分(APACHE-Ⅱ评分)、序贯器官衰竭评分(SOFA评分)的相关性；采用ROC曲线分析HBP、IL-6、IL-18对脓毒症患者预后的评估价值。结果普通感染组、脓毒症组的HBP、IL-6、IL-18明显低于脓毒症休克组，差异有统计学意义(P < 0.001)；死亡组的HBP、IL-6、IL-18明显高于存活组，差异有统计学意义(P < 0.001)。HBP、IL-6、IL-18与SOFA评分和APACHE-Ⅱ评分呈正相关关系。HBP、IL-6、IL-18单独预测脓毒症患者预后的ROC曲线下面积分别为0.769、0.793、0.818，约登指数分别为0.460、0.491、0.553，3项指标联合预测脓毒症患者预后的ROC曲线下面积为0.842，约登指数为0.587，3项指标联合的预测价值更高。结论 HBP、IL-6、IL-18血清水平可有效反映脓毒症患者的病情严重程度，且3种炎症因子联合检测时对脓毒症患者的预后比各指标单独检测的评估效能更高。
- 肝素结合蛋白 /
- 白介素-18 /
- 白介素-6 /
- 脓毒症 /
- 预后
Abstract: Objective Sepsis is associated with high mortality and rapid progression. To evaluate the prognosis and disease severity in septic patients, this study analyzed the expression levels of heparin-binding protein (HBP), interleukin (IL)-6, and IL-18 to explore their predictive value. Methods Eighty patients admitted to the Emergency Medicine Department and ICU of the First Affiliated Hospital of Bengbu Medical University from January 2023 to June 2024 were selected. According to the diagnostic criteria of sepsis, they were divided into the non-sepsis group, namely 20 cases in the common infection group, 35 cases in the sepsis group, and 25 cases in the septic shock group. The levels of HBP, IL-18 and IL-6 in the three groups of patients were compared. Taking 28 days as the endpoint of the study, patients with sepsis were divided into the survival group and the death group, and the levels of HBP, IL-18 and IL-6 in the two groups were compared. Pearson analysis was used to compare the correlations between HBP, IL-18, IL-6 and acute physiology and chronic health evaluation-Ⅱ score (APACHE-Ⅱ) score and sequential organ failure assessment (SOFA) score. The ROC curve was used to analyze the evaluation of the prognosis of patients with sepsis by HBP, IL-6 and IL-18. Results The HBP, IL-6 and IL-18 values of the common infection and septic group were significantly lower than the septic shock group (P < 0.001); the HBP, IL-6 and IL-18 values were significantly higher than the surviving group, respectively (P < 0.001). Moreover, HBP, IL-6 and IL-18 values showed significant positive correlation with SOFA score and APACHE-Ⅱ score. When HBP, IL-6 and IL-18 were tested separately, the area under the curve was 0.769, 0.793 and 0.818, respectively, and the Youden index was 0.460, 0.491 and 0.553, respectively. When the three indicators were tested jointly, the area under the ROC curve was 0.842 and the Youden index was 0.587, and the combined test value was higher than the single test value. Conclusion By comparing the serum levels of HBP, IL-6 and IL-18 in three groups, the severity of sepsis patients can be effectively reflected, and the combined detection of the three inflammatory factors has better evaluation efficiency than the single index alone.
- Heparin-binding protein /
- Interleukin-18 /
- Interleukin-6 /
- Sepsis /
- Prognosis

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图 1 3种炎症因子单独及联合预测脓毒症患者预后的ROC曲线

Figure 1. ROC curves for predicting the prognosis of sepsis patients using three inflammatory factors individually and in combination

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表 1 普通感染组、脓毒症组和脓毒症休克组患者一般资料比较

Table 1. General infection group, sepsis group, and septic shock group

项目	普通感染组(n=20)	脓毒症组(n=35)	脓毒症休克组(n=25)	统计量	P值
性别(男性/女性，例)	10/10	22/13	16/9	1.111^a	0.292
年龄(x±s，岁)	69.60±14.75	68.68±13.65	67.76±8.27	0.120^b	0.886
BMI(x±s)	24.52±2.49	23.74±2.13	23.67±2.85	0.816^b	0.445
基础疾病[例(%)]
高血压	10(50.00)	13(37.14)	12(48.00)	1.122^a	0.571
糖尿病	7(35.00)	10(28.57)	8(32.00)	0.254^a	0.881
冠心病	5(25.00)	15(42.86)	9(36.00)	1.757^a	0.415
脑梗死	6(30.00)	7(20.00)	4(16.00)	1.359^a	0.507
感染部位[例(%)]				0.435^a	0.427
呼吸系统	9(45.00)	20(57.14)	8(32.00)
泌尿系统	4(20.00)	5(14.29)	6(24.00)
消化系统	7(35.00)	10(28.57)	11(44.00)
WBC[M(P₂₅, P₇₅)，×10⁹/L]	7.49(5.65, 12.57)	12.75(8.46, 15.25)	8.57(5.59, 18.37)	5.741^c	0.057
CRP[M(P₂₅, P₇₅)，mg/L]	75.42(56.85, 108.89)	117.80(65.51, 170.13)	119.32(61.25, 166.85)	4.326^c	0.105
SCr(x±s，μmol/L)	101.09±25.22	94.72±17.24	103.71±19.47	0.371^b	0.690
注：^a为χ²值，^b为F值，^c为H值。

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表 2 普通感染组、脓毒症组和脓毒症休克组HBP、IL-6、IL-18水平及APACHE-Ⅱ评分、SOFA评分比较(x ±s)

Table 2. HBP, IL-6, IL-18, APACHE Ⅱ score, and SOFA score in the general infection, sepsis, and septic shock group (x ±s)

组别	例数	HBP(ng/mL)	IL-6(pg/mL)	IL-18(pg/mL)	APACHE-Ⅱ评分(分)	SOFA评分(分)
普通感染组	20	37.25±1.37	44.75±2.55	87.30±5.19
脓毒症组	35	69.74±4.80^a	60.25±3.95^a	106.31±12.75^a	15.02±2.91	7.51±1.90
脓毒症休克组	25	80.40±5.74^ab	90.48±8.54^ab	133.80±14.63^ab	23.12±4.85	15.88±2.31
统计量		528.087^c	402.232^c	85.857^c	8.045^d	15.345^d
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：与普通感染组比较，^aP < 0.001；与脓毒症组比较，^bP < 0.001。^c为F值，^d为t值。

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表 3 HBP、IL-6、IL-18与APACHE-Ⅱ评分、SOFA评分的相关性分析

Table 3. Correlation analysis of HBP, IL-6, and IL-18 with APACHE Ⅱ and SOFA scores

指标	APACHE Ⅱ评分		SOFA评分
指标	r值	P值	r值	P值
IL-6	0.707	< 0.001	0.868	< 0.001
HBP	0.588	< 0.001	0.679	< 0.001
IL-18	0.735	< 0.001	0.759	< 0.001

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表 4 不同预后脓毒症患者HBP、IL-6、IL-18水平和APACHE-Ⅱ评分、SOFA评分比较

Table 4. Comparison of HBP, IL-6, IL-18 levels, APACHE Ⅱ scores, and SOFA scores in sepsis patients with different prognoses

组别	例数	HBP (x±s, pg/mL)	IL-6 (x±s, pg/mL)	IL-18 (x±s, pg/mL)	APACHE-Ⅱ评分 (x±s, 分)	SOFA评分 [M(P₂₅, P₇₅), 分]
生存组	46	72.63±7.06	69.52±13.85	112.82±17.93	16.93±4.95	10.16(6.62，13.77)
死亡组	14	79.28±6.26	84.85±17.54	134.01±13.57	23.57±5.24	12.77(9.73, 16.95)
统计量		3.162^a	3.403^a	4.066^a	4.339^a	-2.027^b
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.043
注：^a为t值，^b为Z值。

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表 5 HBP、IL-6、IL-18对脓毒症患者预后的预测效能

Table 5. Predictive efficacy of HBP, IL-6, and IL-18 for sepsis prognosis

项目	AUC	95% CI	P值	截断值	约登指数	灵敏度 (%)	特异度 (%)
HBP	0.769	0.640~0.898	< 0.001	74.5	0.460	78.6	67.4
IL-6	0.793	0.661~0.924	< 0.001	87.0	0.491	85.7	69.6
IL-18	0.818	0.711~0.920	< 0.001	121.5	0.553	64.3	84.8
三者联合	0.842	0.741~0.942	< 0.001		0.587	92.9	65.2

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