血浆可溶性髓样细胞触发受体-1对脓毒症早期诊断的价值及预后意义  

The diagnostic value and prognostic significance of plasma soluble triggering receptor -1 on myeloid cells- 1 in patients with sepsis

作　　者：王洪霞[1] 陈兵[1] 

机构地区：[1]天津医科大学第二医院急诊科,天津300211

出　　处：《中华急诊医学杂志》2011年第8期803-806,共4页Chinese Journal of Emergency Medicine

基　　金：天津市卫生局科技基金资助项目（09KZ93）

摘　　要：目的探讨血浆可溶性髓样细胞触发受体-1（soluble triggering receptor expressed on myeloid cells-1，sTREM-1）对脓毒症早期诊断的价值及预后意义。方法采用前瞻性病例对照研究。将2009年5月至2010年6月天津医科大学第二医院重症监护病房（ICU）收治的56例系统性炎症反应综合征（SIRS）患者，根据2001年国际脓毒症会议诊断标准分为脓毒症组32例、SIRS组24例，同时收集非SIRS患者25例作为对照组，根据28d转归将脓毒症组分为生存组和死亡组两个亚组。入院24h内测定血常规、血气分析、血生化、降钙素原（PCT）、C反应蛋白（CRP），记录最高体温（T），进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分；采用酶联免疫吸附法（ELISA）检测sTREM-1水平。采用SPSS16．0统计分析软件进行数据处理，计量资料采用方差或Kruskal-WallisH检验，相关性分析采用Spearman相关系数。结果血浆sTREM-1水平脓毒症组高于SIRS组及对照组[分别为250．9（195．8～354．3）ng/L、103．6（89．4～166．2）ng／L、33．6（26．2—43．0）ng／L，P〈0．01]，死亡组高于生存组[分别为360．5（262．2～434．5）ng／L、204．1（175．0～269．6）ng／L，P〈0．01]；脓毒症组患者血浆sTREM-1水平与APACHEII评分呈正相关（rs=0．426，P：0．032）；sTREM-1 ROC曲线下面积为0．935，高于PCT、CRP。结论血浆sTREM-1水平对脓毒症早期诊断有一定意义，早期sTREM-1水平升高与不良预后相关。Objective To investigate the diagnostic value and prognostic significance of plasma soluble triggering receptor - 1 on myeloid cells （ sTREM - 1 ） in patients with sepsis in the early stage. Methods A total of 56 patients with systemic inflammatory response syndrome （SIRS） were enrolled for prospective and control study from May 2009 through July 2010. According to the criteria of sepsis set by SCCN/ESICM/ACCP/ATS/SIS in 2001, patients were divided into sepsis group （n = 32） , SIRS group （n = 24） . Meanwhile, 25 non- SIRS patients were enrolled in the control group. The sepsis group was further divided into two subgroups, namely survival subgroup and non - survival subgroup according to 28 - day outcomes. The sTREM - 1, procalcitonin （PCT） , C - reactive protein （CRP） , white blood cell count and neutrophil percentage count （NPC） were measured and APACHE Ⅱ scores were determined within 24 hours after admission. The correlation between sTREM - 1 and APACHE Ⅱ score was analyzed. Quantitative data were analyzed by using F - test or Kruskal - Wallis test. Results The plasma level of sTREM -1 in patients of sepsis group was significantly higher than that in SIRS group and control group [215.1 （157.9 -397.3） ng/L vs 103.6 （89.4 -176.2） ng/L vs 33.6 （26.2 - 43.0） ng/L, P〈 0. 05 ] . The plasma level of sTREM - 1 in non - survival group was significantly higher than that in survival group [360. 5 （262. 2 -434.5） ng/L vs 204. 1 （175.0 -269.6） ng/L, P =0. 002] . In sepsis group, the plasma level of sTREM - 1 was positively correlated with APACHE II score （ r = 0. 426, P = 0. 032 ） . The area under the ROC curve of sTREM - 1 was 0. 935, larger than that of PCT and CRP. Conclusions Plasma sTREM - 1 is a useful marker in diagnosis of sepsis at early stage. The increase in the level of sTREM - 1 during the first 24 hours might be correlated with poor outcome of patients with sepsis.

关 键 词：脓毒症 髓样细胞触发受体-1 可溶性 诊断 预后 急性生理学与慢性健康状况评分系统Ⅱ评分 酶联免疫吸附测定 降钙素原 C反应蛋白 

分 类 号：R459.7[医药卫生—急诊医学]