血漿中介白質激素6之濃度與成人菌血症風險之關聯研究

Abstract

背景. 敗血症的嚴重程度與血中細胞激素的上升與持續時間長短是被認為有相關性的存在。而在所有與敗血症相關的細胞激素中，細胞激素介白質6在對抗侵入的微生物所產生的發炎反應中佔有著重要的角色。但是先前的研究並沒有清楚的探討菌血症病人血漿中介白質激素6的濃度高低與之後敗血症的嚴重程度之相關性。 研究方法. 本研究總共收集了109位來自於台灣北部一家區域教學醫院的普通病房及加護病房之菌血症住院病人。每一位菌血症住院病人於告知病情取得同意書後，各抽取兩次血液檢體，且兩次檢體時間至少間隔48個小時以上。 研究結果.在患有糖尿病的菌血症病人中且血漿中介白質激素6為最低的三分之一層級者比起最高的三分之一層級者，敗血症的嚴重程度相對來說是有較低的危險相關性 (OR=0.13, 95% CI=0.02- 0.82)。在年齡大於等於75歲的菌血症病人，血漿中介白質激素6持續上升與器官功能衰竭是有顯著危險相關性的存在 (OR=9.36, 95% CI=1.59- 55.10)。在革蘭氏陽性球菌菌血症病人比起革蘭氏陰性桿菌菌血症病人與血漿介白質激素6的升高有較大的關聯性 (OR=2.58 95% CI=1.03-6.46)。在革蘭氏陽性球菌菌血病人帶有褥瘡者比起革蘭氏陰性桿菌菌血症帶有褥瘡者也是與血漿中介白質激素6的上升有關聯 (OR=12.15, 95% CI=1.17- 125.61)。在革蘭氏陽性球菌菌血病人未在48小時內接受適當抗生素治療者比起同樣未接受適當抗生素治療的革蘭氏陰性桿菌菌血症的患者也是與血漿中介白質激素6的上升有關聯性 (OR=9.44, 95% CI=1.34- 66.28)。 結論. 血漿中介白質激素6是關於敗血症的嚴重程度的預測因子並且與引起菌血症的菌種不同而有關聯性存在。

Background. The severity of sepsis has been associated with high and sustained cytokine levels. Interleukin 6 (IL-6) plays a pivotal role in the inflammatory response against pathogens. However, the association between plasma IL-6 levels in bacteremic patients and the severity of sepsis has not been well explored. Methods. A total of 108 bacteremic patients were recruited from the general ward and intensive care unit (ICU) of a teaching hospital in northern Taiwan. For each patient, two plasma IL-6 levels were determined at least 48 hours apart after admission to the general ward and ICU. Results. Among bacteremic patients with diabetes mellitus (DM), the lowest tertile of the first plasma IL-6 level was associated with a reduced risk of severe sepsis (OR=0.13, 95% CI=0.02-0.82) compared with the highest tertile. Sustained elevation of IL-6 was associated with organ dysfunction in patients 75 old and older (OR=9.36, 95% CI=1.59-55.10). Bacteremic patients with G (+) cocci infection had higher plasma IL-6 levels (OR=2.58, 95% CI=1.03-6.46) than those with G (-) bacilli. Among bacteremic patients with pressure ulcers, those with G (+) cocci infection had higher plasma IL-6 levels (OR=12.15, 95% CI=1.17-125.61) than those with G (-) bacilli infection. Discordant antibiotic therapy in patients with G (+) cocci bacteremia was related to an increased plasma IL-6 level (OR=9.44, 95% CI=1.34-66.28) compared with that in those with G (-) bacilli. Conclusion. Plasma IL-6 is an important predictor of sepsis severity and this association varies by the type of causative pathogen.