摘要目的:探讨外周血白细胞介素（IL）-17、IL-8表达与脓毒症患者短期预后的关系。方法:回顾性分析湖州市中心医院2020年1月至2024年1月收治的158例脓毒症患者资料，重点记录研究所需结果资料，包括患者病情严重程度（脓毒症138例，脓毒性休克20例）、基线资料及短期预后（即28 d死亡情况），比较不同病情严重程度、不同预后患者入院时降钙素原（PCT）、外周血IL-17、IL-8等实验室指标水平，采用COX回归模型分析及交互作检验验证外周血IL-17、IL-8水平与脓毒症患者短期预后的关系，绘制受试者工作特征（ROC）曲线并构建决策曲线，分析外周血IL-17、IL-8水平对脓毒症患者短期预后的预测价值。结果:不同病情严重程度脓毒症患者入院时外周血IL-17、IL-8水平比较，脓毒性休克组高于脓毒症组[（82.48 ± 13.54）μg/L比（62.84 ± 12.09）μg/L、（41.80 ± 5.46）ng/L比（34.22 ± 6.77）ng/L）]，差异有统计学意义（ P<0.05）；病死组入院时急性生理与慢性健康状况评分Ⅱ、PCT、IL-17、IL-8水平均高于存活组，脓毒性休克患者占比高于存活组[（12.09 ± 2.06）分比（10.81 ± 2.36）分、（2.23 ± 1.18）μg/L比（1.78 ± 0.69）μg/L、（79.24 ± 13.72）μg/L比（61.37 ± 11.15）μg/L、（42.43 ± 5.07）ng/L比（33.09 ± 6.14）ng/L、51.43%（18/35）比1.63%（2/123）]，差异有统计学意义（ P<0.05）。COX回归分析显示，脓毒症患者短期预后与外周血IL-17、IL-8水平表达异常有关，二者均高表达可能是脓毒症患者短期预后的危险因素（ P<0.05）；外周血IL-17、IL-8水平对脓毒症患者短期预后存在正向交互作用，二者均高表达时死亡风险是二者均低表达时的97.500倍，协同作用相应为二者单独存在产生效应之和的9.362倍（交互作用指数= 9.362）。绘制ROC曲线，获取曲线下面积（AUC），外周血IL-17、IL-8单独及联合预测脓毒症患者短期预后风险的AUC分别为0.839、0.889、0.960，均有较理想的预测价值，且联合预测价值高于二者单独应用（ Z = 3.85、2.66， P<0.05）。绘制决策曲线，当阈值为0.1～1.0时，外周血IL-17、IL-8水平联合预测模型预测脓毒症患者短期预后风险的净收益率优于单纯IL-17、IL-8，最大净收益率为0.222。 结论:脓毒症患者病情越严重，外周血IL-17、IL-8水平表达越高，可能提示患者存在短期死亡高风险，早期联合检测脓毒症患者外周血IL-17、IL-8水平可预测其短期预后风险。

abstractsObjective:To explore the relationship between the expression of peripheral blood interleukin-17 (IL)-17 and IL-8 and the short-term prognosis of sepsis patients.Methods:The data of 158 patients with sepsis admitted to Huzhou Central Hospital from January 2020 to January 2024 were retrospectively collected. The patient′s data were carefully reviewed, and the results of the study were recorded, including the severity of the patient′s condition (138 cases of sepsis, 20 cases of septic shock), baseline data, and short-term prognosis (28-day mortality). The levels of procalcitonin (PCT), peripheral blood IL-17, IL-8, and other laboratory indicators were compared between patients with different severity and different prognosis. COX regression model analysis and interaction test were used to verify the relationship between peripheral blood IL-17, IL-8 levels, and short-term prognosis in patients with sepsis. The receiver operating characteristic (ROC) curve was drawn and the decision curve was constructed to analyze the predictive value of peripheral blood IL-17 and IL-8 levels on the short-term prognosis of patients with sepsis.Results:The levels of IL-17 and IL-8 in the peripheral blood of patients with different severity of sepsis at admission were higher in the septic shock group than those in the sepsis group: (82.48 ± 13.54) μg/L vs. (62.84 ± 12.09) μg/L, (41.80 ± 5.46) ng/L vs. (34.22 ± 6.77) ng/L,( P<0.05). The acute physiology and chronic health evaluation (APACHE) Ⅱ score, PCT, IL-17, and IL-8 levels at admission in the death group were higher than those in the survival group, and the proportion of patients with septic shock was higher than that in the survival group: (12.09 ± 2.06) points vs. (10.81 ± 2.36) points, (2.23 ± 1.18) μg/L vs. (1.78 ± 0.69) μg/L, (79.24 ± 13.72) μg/L vs. (61.37 ± 11.15) μg/L, (42.43 ± 5.07) ng/L vs. (33.09 ± 6.14) ng/L, 51.43%(18/35) vs. 1.63%(2/123), P<0.05. COX regression analysis showed that the short-term prognosis of patients with sepsis was related to the abnormal expression of IL-17 and IL-8 in peripheral blood. The high expression of both may be a risk factor for the short-term prognosis of patients with sepsis ( P<0.05). The levels of IL-17 and IL-8 in peripheral blood had a positive interaction on the short-term prognosis of patients with sepsis. The risk of death when both were highly expressed was 97.500 times that when both were lowly expressed and the synergistic effect was 9.362 times higher than the sum of the effects produced by the two alone (synergy index = 9.362). ROC curve was drawn to obtain the area under the curve (AUC). The AUC of peripheral blood IL-17, IL-8 alone and combined to predict the short-term prognosis risk of sepsis patients were 0.839, 0.889 and 0.960, respectively, which had ideal predictive value, and the combined predictive value was higher than that of the two alone ( Z = 3.85, 2.66, P<0.05). The decision curve was drawn. When the threshold was 0.1-1.0, the net return rate of the combined prediction model of IL-17 and IL-8 in peripheral blood to predict the short-term prognosis risk of sepsis patients was better than that of IL-17 and IL-8 alone, and the maximum net return rate was 0.222. Conclusions:The more severe the condition of sepsis patients, the higher the expression of IL-17 and IL-8 in peripheral blood, which may suggest that patients have a high risk of short-term death. Early combined detection of IL-17 and IL-8 levels in the peripheral blood of sepsis patients can predict their short-term prognostic risk.