白细胞介素-6对糖尿病酮症酸中毒早期判别预后的作用

摘要

目的 探讨白细胞介素-6(interleukin-6,IL-6)对糖尿病酮症酸中毒(diabeticketoacidosis,DKA)患者预后的判别意义.方法 前瞻性连续入选浙江大学医学院附属邵逸夫医院急诊科2010年6月1日至2012年12月31日急诊就诊并且按诊断标准明确诊断为DKA患者88例,随访28 d按照患者预后分为死亡组(12例)和存活组(76例)两组,采用两独立样本t检验的方法比较两组患者入院后24 h内血清IL-6质量浓度,对就诊24h内的IL-6质量浓度与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清乳酸(lactate,Lac)和血气分析中碱剩余(base excess,BE)绝对值进行相关性分析,并描绘24 h IL-6值的受试者工作特征曲线(ROC曲线),分析IL-6值在发病早期判别预后的意义.结果 死亡组患者在入院24 h内IL-6质量浓度较存活组明显升高.DKA患者入院24 h内IL-6质量浓度的ROC曲线下面积为0.783,最佳28 d死亡预测界值为448.9 ng/L;且IL-6质量浓度与APACHEⅡ评分(相关系数r=0.919,P=0.005),Lac(相关系数r=0.922,P=0.003)和BE绝对值(相关系数r=0.887,P=0.015)均呈显著正相关.结论 血清IL-6质量浓度可以在DKA发病早期对患者进行预后判断.%Objective To investigate the value of interleukin-6 (IL-6) level as a prognostic indicator in diabetic ketoacidosis (DKA) patients.Methods Data of 88 cases of DKA in Sir Run Run Shaw Hospital collected from June 1,2010 to December 31,2012 were analyzed prospectively.They were divided into two groups according to the survival of patients followed up for 28 days:non-survival group (n =12) and survival group (n =76).Serum levels of IL-6,lactate,base excess and APACHE Ⅱ score in 24 hours after admission were compared between two groups by independent t test.The receiver operating characteristic (ROC) curve was plotted to analyze the performance of IL-6 as a prognostic indicator in the early stage of DKA.Correlations between IL-6 value and lactate,base excess,APACHE Ⅱ score were analyzed.Results The IL-6 values were elevated obviously in non-survival group.The ROC of IL-6 had an area under curve (AUC) of 0.783,and the cut-off value of IL-6 for the death followed up for 28 days was 448.9 ng/L.In all patients,IL-6 values and APACHE Ⅱ score showed a positive correlation between them (r =0.919,P =0.005),and also positive correlations existed between IL-6 and lactate as well as base excess (r=0.922,P=0.003; r=0.887,P=0.015)in24 hours.Conclusions IL-6 value is a reliable prognostic indicator in the early stage of DKA.