目的:探讨白细胞介素-6(IL-6)等细胞因子水平对预后的影响。IL-8和TNF(肿瘤坏死因子)-α对重症监护病房(ICU)脓毒症患者的Meta分析。
方法:我们系统地搜索了PubMed,Embase,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),万方,和截至2023年5月的其他数据库,以检索有关细胞因子测试以预测ICU环境中脓毒症预后的临床研究文章。提取相关指标并记录在Excel中。使用RevMan5.3进行Meta分析。
结果:共有25项研究最终纳入本Meta分析:21项调查IL-6,6项检查IL-8,11项解决IL-10,12项审查TNF-α,6集中于IL-1β。Meta分析结果显示,存活组细胞因子(IL-6、IL-8、IL-10、TNF-α和IL-1β)水平显著低于非存活组(ALLP<0.00001)。具体发现包括IL-6的显着差异[SMD=-25.32,95%CI(-27.14,-23.49),P<0.00001],IL-8[SMD=-140.48,95%CI(-154.32,-126.64),P<0.00001],IL-10[SMD=-54.10,95%CI(-56.74,-51.47),P<0.00001],TNF-α[SMD=-8.67,95%CI(-9.82,-7.52),P<0.00001],和IL-1β[SMD=-3.71,95%CI(-4.11,-3.30),P<0.00001]。IL-6、IL-8、IL-10、TNF-α、IL-1β呈大致对称分布,表明研究结果的偏差最小,可靠性高。
结论:细胞因子水平如IL-6、IL-8和TNF-α是ICU中脓毒症患者有价值的预后指标。这些细胞因子的早期测试可以指导临床干预,并能够对高危患者进行针对性治疗,以减少不良结局的可能性。
OBJECTIVE: To explore the prognostic effect of cytokine levels such as IL-6 (interleukin), IL-8 and TNF (tumor necrosis factor)-α on patients with sepsis in intensive care units (ICUs) by Meta-analysis.
METHODS: We systematically searched PubMed, Embase, Web of Science, Cochrane Library,
China National Knowledge Infrastructure (CNKI), Wanfang, and other databases up to May 2023 to retrieve clinical research articles on cytokine testing for predicting sepsis prognosis in ICU settings. Relevant indicators were extracted and recorded in Excel. Meta-analyses were performed using RevMan 5.3.
RESULTS: A total of 25 studies were finally included in this Meta-analysis: 21 investigated IL-6, 6 examined IL-8, 11 addressed IL-10, 12 reviewed TNF-α, and 6 focused on IL-1β. Meta-analysis results demonstrated that cytokine levels (IL-6, IL-8, IL-10, TNF-α and IL-1β) in survival groups were substantially lower than those in non-survival groups (ALL P < 0.00001). Specific findings include significant differences in IL-6 [SMD = -25.32, 95% CI (-27.14, -23.49), P < 0.00001], IL-8 [SMD = -140.48, 95% CI (-154.32, -126.64), P < 0.00001], IL-10 [SMD = -54.10, 95% CI (-56.74, -51.47), P < 0.00001], TNF-α [SMD = -8.67, 95% CI (-9.82, -7.52), P < 0.00001], and IL-1β [SMD = -3.71, 95% CI (-4.11, -3.30), P < 0.00001]. The funnel plots for IL-6, IL-8, IL-10, TNF-α, and IL-1β displayed roughly symmetrical distributions, suggesting minimal bias and high reliability of the findings.
CONCLUSIONS: Cytokine levels such as IL-6, IL-8, and TNF-α are valuable prognostic indicators for patients with sepsis in the ICUs. Early testing of these cytokines can guide clinical interventions and enable targeted treatments for high-risk patients to reduce the likelihood of adverse outcomes.