背景:坏死性筋膜炎(NF)已成为罕见但进展迅速的,危及生命的严重皮肤和软组织感染。我们进行了一项研究,以调查Th1/Th2细胞因子是否可以作为生物标志物来区分NF与III类皮肤和软组织感染(STTI)。
方法:对2020年10月至2022年2月的155例严重皮肤和软组织感染患者进行了回顾性研究。从外周血和伤口引流液样品中获得Th1/Th2细胞因子。关于人口特征的数据,致病微生物,Th1/Th2细胞因子,c反应蛋白,提取降钙素原和白细胞(WBC)进行分析。具有统计学差异(p<0.1)的因素包括在多变量逻辑回归模型中。白细胞介素-2(IL-2)的临床鉴别诊断价值,采用受试者工作特征(ROC)曲线分析IL-6、IL-10、肿瘤坏死因子-α(TNF-α)和干扰素-r(IFN-r)。
结果:在155名患者中,66例(43%)患者被诊断为NF。我们发现性别没有显着差异,年龄,感染部位,共存条件,易感性,入院前症状持续时间和微生物,WBC,NF和III类SSTIs组的降钙素原和C反应蛋白。NF在血清中IL-6水平较高(50.46[24.89,108.89]vs.11.87[5.20,25.32]pg/ml;p<0.01),血清中的IL-10(3.45[2.03,5.12]vs.2.51[1.79,3.29]pg/ml;p<0.01),伤口引流液中的IL-2(0.89[0.49,1.33]vs.0.63[0.14,1.14]pg/ml;p=0.02),伤口引流液中的IL-6(5000.84[1392.30,13287.19]vs.1927.82(336.65,6759.27)pg/ml;p<0.01),伤口引流液中的TNF-a(5.20[1.49,22.97]vs.0.96[0.12,3.21]pg/ml;p<0.01)和伤口引流液中IFN-r(1.32[0.47,4.62]vs.与III类SSTI相比,0.68[0.10,1.88]pg/ml;p=0.02)。多因素logistic回归分析显示血清IL-6,血清IL-10和伤口引流液中TNF-α与NF的诊断有显著的相关性(p<0.05).在ROC曲线分析中IL-2、IL-6、IL-10、TNF-a和IFN-r对NF,血清IL-6的曲线下面积(AUC)可达0.80(p<0.001)。使用27.62pg/ml作为截止值,血清IL-6的敏感性为74%,特异性为79%.
结论:Th1/Th2细胞因子,特别是血清中的IL-6,是早期诊断NF的潜在生物标志物。然而,有多个中心和前瞻性研究的更大的患者群体对于确保Th1/Th2细胞因子的预后作用是必要的.
Necrotizing fasciitis (NF) has emerged as rare but rapidly progressive, life-threatening severe skin and soft tissue infection. We conducted a study to investigate whether Th1/Th2 cytokines could serve as biomarkers to distinguish NF from class III skin and soft tissue infections (SSTIs).
A retrospective review was performed for 155 patients suffering from serious skin and soft tissue infections from October 2020 to February 2022. Th1/Th2 cytokines were obtained from peripheral blood and wound drainage fluid samples. Data on demographic characteristics, causative microbiological organisms, Th1/Th2 cytokines, c-reactive protein, procalcitonin and white blood cell (WBC) were extracted for analysis. Factors with statistical difference(p < 0.1) were included in the multivariate logistic regression model. The clinical differential diagnostic values of interleukin-2(IL-2), IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-r (IFN-r) were analyzed by receiver operating characteristic (ROC) curve.
Among the 155 patients, 66(43%) patients were diagnosed as NF. We found no significant difference for sex, age, location of infection, coexisting condition, predisposition, duration of symptoms before admission and micro-organisms, WBC, procalcitonin and c-reactive protein in NF and class III SSTIs group. NF had higher levels of IL-6 in serum (50.46 [24.89, 108.89] vs. 11.87 [5.20, 25.32] pg/ml; p<0.01), IL-10 in serum (3.45 [2.03, 5.12] vs. 2.51 [1.79, 3.29] pg/ml; p<0.01), IL-2 in wound drainage fluid (0.89 [0.49, 1.33] vs. 0.63 [0.14, 1.14] pg/ml; p = 0.02), IL-6 in wound drainage fluid (5000.84 [1392.30, 13287.19] vs. 1927.82 (336.65, 6759.27) pg/ml; p<0.01), TNF-a in wound drainage fluid (5.20 [1.49, 22.97] vs. 0.96 [0.12, 3.21] pg/ml; p<0.01) and IFN-r in wound drainage fluid (1.32 [0.47, 4.62] vs. 0.68 [0.10, 1.88] pg/ml; p = 0.02) as compared to the class III SSTIs. Multivariate logistic regression analyses showed that IL-6 in serum, IL-10 in serum and TNF-a in wound drainage fluid exhibited independently significant associations with diagnosis of NF(p<0.05). In ROC curve analysis of IL-2, IL-6, IL-10, TNF-a and IFN-r for diagnosis of NF, the area under the curve (AUC) of IL-6 in serum could reach to 0.80 (p<0.001). Using 27.62 pg/ml as the cut off value, the sensitivity was 74% and the specificity was 79% in IL-6 in serum.
Th1/Th2 cytokines, IL-6 in serum in particular, are potential biomarkers for the diagnosis of NF in the early stage. However, larger patient populations with multiple centers and prospective studies are necessary to ensure the prognostic role of Th1/Th2 cytokines.