Correlation Analysis Of Disease Severity And Serum Inflammatory Factors(TNF-α、IFN-γ、IL-4、IL-10)in Patients With Sepsis

Objective: To investigate the correlation between serum inflammation-related factors(TNF-α,IFN-γ,IL-4,IL-10)and disease severity within 72 hours of sepsis diagnosis in patients with sepsis of different severity.Methods: Fifty patients with sepsis admitted to the ICU of the First Affiliated Hospital of Shihezi University School of Medicine from October 2021 to October 2022 were selected(patients were divided into 16 patients in the mild group(APACHE Ⅱ ≤ 15),16 patients in the moderate group(15 < APACHE Ⅱ≤ 25),and 18 patients in the severe group(APACHE Ⅱ > 25)according to APACHE Ⅱ score)as the experimental group;20 cases were selected as the normal control group for the same period of healthy physical examination in our hospital.In the sepsis patients,5 ml of peripheral venous blood was collected at the time of diagnosis(0h),6h,12 h,24h,48 h and 72 h,and 5 ml of peripheral venous blood was collected from the control group at the time of physical examination,and the serum was stored in a refrigerator at-80℃after high speed centrifugation,and the expression levels of serum inflammatory factors TNF-α,IFN-γ,IL-10 and IL-4 were measured by Elisa method.The differences between pro-inflammatory factors and anti-inflammatory factors in the severe,moderate and mild groups were compared to investigate the dynamic changes of pro-inflammatory cytokines(TNF-α,IFN-γ)and anti-inflammatory cytokines(IL-10,IL-4)after the inflammatory response of the body and their correlation with the severity of sepsis disease in clinical patients.Results:(1)Comparison between groups at the time of diagnosis : serum TNF-α,IFN-γ,IL-10 and IL-4 levels were highest in the severe group,followed by the moderate group,the mild group and the healthy control group in that order.The intergroup differences of serum TNF-α,IFN-γ,IL-10 and IL-4 were all significant(P < 0.001).TNF-α and IFN-γ: there was a statistical difference between the two comparisons in the severe,moderate,mild and control groups(P < 0.05);IL-10 and IL-4: there was no statistical difference between the mild and control groups(P > 0.05),and the two comparisons in the severe,moderate group and mild group were statistically different(P < 0.05).(2)Comparison of cytokine changes among experimental groups: Overall test of TNF-α and IFN-γ : the main effect of time was significant(P < 0.001),indicating that the concentration changes of TNF-α and IFN-γ were statistically different in each group at each detection time point.The main effect was significant in all groups(P < 0.001),indicating that the changes of TNF-α and IFN-γ were statistically different among all groups at each detection time point.Overall test of IL-10 and IL-4: the main effect of time was significant(P < 0.001),indicating that there were statistical differences in the concentration changes of IL-10 and IL-4 at each detection time point in each group.The main effect was significant in all groups(P< 0.001),indicating that the concentration changes of IL-10 and IL-4 were statistically different among all groups at each detection time point.(3)The change trend of cytokines in each experimental group: in mild group,TNF-α and IFN-γ increased gradually from 0h to 48 h and reached the peak value,and decreased from 48 h to 72 h,while IL-10 and IL-4 increased gradually from 0h to 72 h.In the moderate group,TNF-α and IFN-γ increased gradually from 0h to 24 h,then decreased from 24 h to 72 h,and IL-10 and IL-4 increased gradually within 72 h.In severe group,the concentration of TNF-α increased rapidly from 0h to 12 h,and then decreased at 24 h and then gradually increased.IFN-γ increased rapidly from 0h to 24 h,then decreased from 24 h to 48 h,and then showed an upward trend.IL-10 increased rapidly from 0h to 24 h at the time of diagnosis,and exceeded the level of IFN-γ.The increase rate slowed down from 24 h to 72 h,but it was still faster than TNF-α and IFN-γ.IL-4increased gradually within 72 h.(4)Correlation: mild group,At 48 h detection point,there was a positive correlation between TNF-α and IL-10,and no correlation between IFN-γ and IL-10(P < 0.05).At 72 h detection point,there was no correlation between TNF-α,IFN-γ and IL-10(P > 0.05).In moderate group,IFN-γ was negatively correlated with IL-10 at 48 h and 72h(P < 0.05),while TNF-α was negatively correlated with IL-10 at 72h(P < 0.05).In severe group,there were significant positive correlations between TNF-α,IFN-γ and IL-10 at48 h and 72 h detection points(P < 0.05).Conclusions:(1)Serum levels of inflammation-related cytokines(pro-inflammatory cytokines TNF-α,IFN-γ; Anti-inflammatory factors IL-10 and IL-4)were closely related to disease severity.(2)Within 72 h after diagnosis of sepsis,the dynamic patterns of cytokine changes differed according to the grading of the disease;the more severe the disease,the earlier the peak of pro-inflammatory factors TNF-α and IFN-γ appeared.(3)The early expression of pro-inflammatory factors is predominant in patients with mild sepsis,while patients with severe disease may have an imbalance between pro-inflammatory and anti-inflammatory responses at an early stage,suggesting an immune dysfunction or even immune paralysis.(4)Based on the change pattern of pro-inflammatory factors TNF-α and IFN-γ;anti-inflammatory factors IL-10 and IL-4,we initially determined the degree of SIRS/ CARS of anti-inflammatory response syndrome,to evaluate the immune function status of patients and provide new ideas for regulating immune response after inflammatory stimulation.