基于Th1/Th2细胞因子检测的脓毒症免疫状态分型及预后分析：一项回顾性研究

沙桐; 王文研; 宣佳斌; 吴洁; 石能贤; 何劲; 胡鸿彬; 张耀元

doi:10.12122/j.issn.1673-4254.2026.01.02

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (01) : 6 -22. DOI: 10.12122/j.issn.1673-4254.2026.01.02

基于Th1/Th2细胞因子检测的脓毒症免疫状态分型及预后分析：一项回顾性研究

沙桐 ¹ ,
王文研 ² ,
宣佳斌 ¹ ,
吴洁 ¹ ,
石能贤 ¹ ,
何劲 ¹ ,
胡鸿彬 ¹ ,
张耀元 ¹

作者信息 +

Identification of immune status subtypes and prognostic analysis of septic patients based on Th1/Th2 cytokine assays

Tong SHA ¹ ,
Wenyan WANG ² ,
Jiabin XUAN ¹ ,
Jie WU ¹ ,
Nengxian SHI ¹ ,
Jin HE ¹ ,
Hongbin HU ¹ ,
Yaoyuan ZHANG ¹

Author information +

文章历史 +

PDF (2528K)

摘要

目的通过Th1/Th2细胞因子数据识别具有不同炎症特征的脓毒症亚型以制定个性化治疗方案，改善患者预后。方法在南方医科大学南方医院数据库中检索2020年6月1日~2022年2月1日期间接受Th1/Th2细胞因子检测的脓毒症患者数据。通过无监督K-均值聚类方法，根据Th1/Th2细胞因子水平对研究对象进行分类，主要研究终点为入ICU后7 d死亡率。采用Cox比例风险模型和限制平均生存时间（RMST）分析不同类型患者的生存结局。结果共纳入321例脓毒症患者。IL-6（HR=1.69，95% CI：1.22~2.34）和IL-10（HR=1.81，95% CI：1.37~2.40）被确定为患者入ICU后7 d内死亡率的独立预测因子。无监督K-均值聚类分析识别出3种炎症/免疫亚组：亚组1（n=166，低炎症反应）、亚组2（n=99，中度炎症反应伴免疫抑制）、亚组3（n=56，强烈炎症和免疫抑制）。与亚组1相比，亚组2和亚组3的患者入ICU后7 d内死亡风险更高（14.4% vs 23.2%，HR=4.30，95% CI：1.51~12.26； 14.4% vs 35.7%， HR=7.32， 95% CI：2.57~20.79）。结论处于保护性免疫反应状态（亚组1）的脓毒症患者短期预后较好，提示准确识别患者的炎症/免疫状态对精准治疗和改善结局的重要性。

Abstract

Objective Sepsis patients exhibit diverse immune states, making it crucial to identify subtypes with distinct inflammatory profiles through Th1/Th2 cytokine data for personalized treatment and improved prognosis. Methods We retrieved data from sepsis patients who underwent Th1/Th2 cytokine testing in Nanfang Hospital, Southern Medical University from June 1, 2020, to February 1, 2022. An unsupervised K-means clustering method classified participants based on Th1/Th2 cytokine levels, with the primary outcome being the 7-day mortality rate post-ICU admission. Cox proportional hazards and Restricted Mean Survival Time (RMST) analyses were utilized to explore survival outcomes. Results A total of 321 sepsis patients were included. IL-6 (HR 1.69, 95%CI: 1.22, 2.34) and IL-10 (HR 1.81, 95% CI: 1.37, 2.40) emerged as independent predictors of 7-day mortality. Unsupervised K-means clustering revealed 3 inflammatory/immune subgroups: Cluster 1 (n=166, low inflammatory response), Cluster 2 (n=99, moderate inflammatory response with immune suppression), and Cluster 3 (n=56, strong inflammatory and immune suppression). Compared to Cluster 1, Clusters 2 and 3 had higher 7-day mortality risks (14.4% vs 23.2%, HR=4.30, 95% CI: 1.51-12.26; 14.4% vs 35.7%, HR=7.32, 95% CI: 2.57-20.79). Conclusion Septic patients in a protective immune response state (Cluster 1) exhibit better short-term prognoses, suggesting the importance of understanding inflammatory/immune states for precise treatment and improved outcomes.