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目的探讨血清IL-10、IL-13、IL-15水平在慢性肝功能衰竭患者中的变化和在医院感染发生、发展中的意义。方法采用双抗体夹心ELISA法检测58例慢性肝功能衰竭患者入院时及入院2周时血清IL-10、IL-13、IL-15水平。结果入院时IL-15值及IL-15/IL-10、IL-15/IL-13比值比较,慢性肝功能衰竭组明显高于健康对照组[(358.16±290.91)ng/L比(38.55±21.49)ng/L、12.93±14.26比1.10±0.55、98.55±97.55比9.70±5.03,均P=0.000],死亡组明显高于治疗好转组[(479.93±205.52)ng/L比(244.51±236.29)ng/L、17.65±17.78比8.53±7.98、130.69±115.50比68.55±65.99,均P<0.05)。入院2周时医院感染组IL-10、IL-13、IL-15值明显高于无医院感染组[(383.49±147.04)ng/L比(75.19±85.68)ng/L、(47.75±20.96)ng/L比(14.47±17.66)ng/L、(582.61±334.09)ng/L比(322.17±239.49)ng/L,P<0.01],未发生医院感染者及好转组血清IL-10、IL-13值明显高于死亡组[(104.34±104.24)ng/L比(39.18±29.98)ng/L、(20.14±21.61) ng/L比(7.46±6.56)ng/L,P<0.05)。入院2周与入院时IL配对比较,医院感染组中好转组IL-10、IL-13明显高于入院时(P<0.01)。结论慢性肝功能衰竭患者存在异常的细胞免疫应答,合并医院感染后可能进一步激活辅助性T淋巴细胞(Th)1/Th2,加重免疫功能紊乱。联合检测血清IL-10、IL-13、IL-15值有助于预后判断和指导治疗,并可能作为早期发现医院感染的检验指标。
Objective To investigate the changes of serum IL-10, IL-13 and IL-15 levels in patients with chronic liver failure and their significance in the occurrence and development of nosocomial infections. Methods Serum levels of IL-10, IL-13 and IL-15 were measured by double antibody sandwich ELISA in 58 patients with chronic liver failure at admission and 2 weeks after admission. Results Compared with the control group, the levels of IL-15, IL-15 / IL-10 and IL-15 / IL-13 in admission to hospital were significantly higher than those in healthy controls [(358.16 ± 290.91) 21.49) ng / L, 12.93 ± 14.26 vs 1.10 ± 0.55,98.55 ± 97.55 vs 9.70 ± 5.03, both P = 0.000]. The death group was significantly higher than that of the treatment group [(479.93 ± 205.52) ng / L (244.51 ± 236.29 ) ng / L, 17.65 ± 17.78 vs 8.53 ± 7.98, 130.69 ± 115.50 vs 68.55 ± 65.99, all P <0.05). The levels of IL-10, IL-13 and IL-15 in hospital infection group at 2 weeks after admission were significantly higher than those without hospitalization [(383.49 ± 147.04) ng / L vs (47. 19 ± 20.66) ng / L, (14.47 ± 17.66) ng / L, (582.61 ± 334.09) ng / L vs (322.17 ± 239.49) ng / L, P <0.01]. No significant difference was found in serum IL-10, IL -13 was significantly higher than that in the death group (104.34 ± 104.24 ng / L, 39.18 ± 29.98 ng / L, 20.14 ± 21.61 ng / L, 7.46 ± 6.56 ng / L, P <0.05). IL-10 and IL-13 in the remission group were significantly higher than those at admission (P <0.01). Conclusions There are abnormal cellular immune responses in patients with chronic liver failure, which may further activate the helper T lymphocytes (Th) 1 / Th2 after hospital infection and aggravate the immune dysfunction. The combined detection of serum IL-10, IL-13 and IL-15 values can be helpful in prognosis and treatment, and may serve as an indicator of early detection of nosocomial infections.