目的 检测和记录脓毒症早期患者白介素(IL)-18、急性生理及慢性健康状况评分(APACHE)Ⅱ及序贯器官功能衰竭评分(SOFA),评价三者对脓毒症早期预后的评估价值.方法 选取38例重症监护病房(ICU)内脓毒症早期患者为脓毒症组,同期住院的20例非脓毒症患者为对照组.根据28 d生存情况分为生存和死亡两种结局.记录患者入选后24 h、48 h、72 h的临床资料,评价APACHEⅡ和SOFA评分,用ELISA法检测血清IL-18.判断其对预后的评估价值.结果 脓毒症组患者确诊后24 h、48 h、72 h时IL-18水平和SOFA评分间均明显高于对照组,差异均有统计学意义(P＜0.05).且随疾病进展,IL-18水平呈下降趋势.两组患者APACHEⅡ在各时间点间差异无统计学意义(P＞0.05).脓毒症患者亚组分析,死亡组IL-18水平、APAHCEⅡ和SOFA评分均明显高于存活组,差异有统计学意义(P＜0.05).结论 IL-18在脓毒症早期表达升高,可以反映疾病进展程度.IL-18与APAHCEⅡ和SOFA评分对脓毒症的预后判断价值相似,可以作为早期脓毒症预后的预测指标.%Objective To determine the serum interleukin ( IL ) 18 levels, APACHE Ⅱ score, and SOFA score in patients with early sepsis and to access their values in pridicting the prognosis. Methods Thirty - eight patients with early spesis from the intensive care unit ( ICU ) were erolled as the sepsis group, with another twenty who were hospitalized during the same period with non - sepsis conditions as the control group. Tow end - points was defined as survival and death , according to the living status on day 28. Clinical data were recorded 24h, 48h, and 72h after erollement respectively , with APACHE Ⅱ score and SOFA score calculated and. IL - 18 levels determined by ELISA. AUC ( Area Under roc Curve ) of the 3 variahles were calculated with their values in predicting the prognosis accessed. Results Serum IL - 18 levels and SOFA score in the sepsis group were significantly higher ( P ＜0. 05 ) than in the control group 24h, 48h, 72h after diagnosed respectively , with IL - 18 levels decreased along with the process of the disease. There were no significant differences in APACHE Ⅱ score between the two groups ( P ＞ 0. 05 ). Serum IL - 18 levels, APACHE Ⅱ score and SOFA score were significantly higher among the death patients according to analysis within the sepsis group ( P ＜ 0. 05 ). Conclusion Levels of serum IL - 18, which elevated in the early stage of sepsis, may reflect the progress of the disease. IL - 18. APACHE Ⅱ score, and SOFA score, with prediction values alike,might be used as indicators of prognosis of early sepsis.
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