【摘要】 目的 评价重症脓毒症患者(severe sepsis) 重症脓毒症患者细胞因子动态表达与预后的相关性。方法 28例重症脓毒症患者，住院期间测定1、3、7、10、13天测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)。结果 28例患者中，12例存活，16例死亡。所有的患者都表达为高的前炎因子和抗炎因子。在所有死亡的病例中，TNF-α在第13天、第17天，IL-6在第3天表达为较高的水平，而IL-10在3天、10天、13天初测到。结论 前炎因子对死亡患者的预见性、相关性不足，抗炎因子中IL-10在第3天、第10天的表达与预后呈负相关。在重症脓毒症患者中动态测定细胞因子的表达是一种早期的、连续的，可预见的方法。

    【关键词】 重症脓毒症；细胞因子；预后

    Cytokine production expression as predictors of outcome for patients with severe sepsis

    CAO Yi-fei, WU Yun-fu, QIAN Yu-jun.

    Suzhou No4 Hospital, Suzhou 215001,China

    【Abstract】 Objective This study was performed to evaluate the impact of cytokine expression as markers of immune status for the final outcome of severe septic patients.Methods The study included 30 patients with severe sepsis due to community-acquired infections. Concentrations of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-10 in serum were determined on admission and on days 3, 10, 13, and 17 during hospitalization.Results Of the 30 patients enrolled, 12 survived, while 16 died during their hospital stay. All patients had significant higher pro- and anti-inflammatory cytokine levels than healthy individuals. In nonsurvivors, higher levels in serum of TNF-α on days 13 and 17; IL-6 levels on day 3; and IL-10 on days 3, 10, and 13 were found. Independent risk factors of mortality were IL-10 levels on days 3 and 10. Several pro- and anti-inflammatory cytokines are oversynthesized during severe infections, especially in patients with a poor outcome.Conclusion Cytokine expression is an early and constant predictive marker for survival in severe sepsis, while serum IL-10 levels on days 3 and 10 have negative prognostic value for the final outcome. ......