血和尿中可溶性髓样细胞触发受体-1对脓毒症患者的早期诊断及预后评估价值  

Values of serum and urine sTREM-1 in the early diagnosis and prognosis of patients with sepsis

作　　者：陈兴旺[1] 赖剑波[1] 姚志军[1] 李健球[1] 陈少霖[1] 周华锋[1] 熊旭明[2] 

机构地区：[1]广州医科大学附属深圳沙井医院ICU,广东省深圳市518104 [2]广州医科大学第二附属医院ICU,510260

出　　处：《实用医学杂志》2013年第23期3874-3877,共4页The Journal of Practical Medicine

基　　金：深圳市宝安区科技计划社会公益科研资助项目(编号:2013150)

摘　　要：目的:初步评价血和尿液中可溶性髓样细胞触发受体-1(sTREM-1)浓度对于脓毒症患者的早期诊断及预后判断价值。方法:收集我院ICU的全身炎症反应综合征(SIRS)患者共84例,根据是否有感染因素分为Sepsis组及SIRS组,根据Sepsis组患者28 d时的生存情况分为死亡组和生存组,测量其入组后1 h的降钙素原(PCT)、C反应蛋白(CRP)、血和尿液sTREM-1的水平,并进行急性生理和慢性健康状态评分(APACHEⅡ评分),绘制ROC曲线分析相关指标对疾病的诊断价值及预后判断,多因素Logistic回归分析探讨与疾病死亡相关的危险因素。结果:Sepsis组患者的CRP、PCT、血sTREM-1和尿sTREM-1要显著高于SIRS组(P<0.05),ROC曲线分析发现血和尿sTREM-1水平对于脓毒症的诊断优于CRP和PCT(0.894,0.800 vs 0.722,0.692);死亡组入组后1 h的APACHEⅡ评分、白细胞计数、CRP、PCT、血sTREM-1和尿sTREM-1均高于生存组,多因素Logistic回归分析显示APACHEⅡ评分、血sTREM-1和尿sTREM-1水平是脓毒症患者预后的独立危险因素。结论:血液和尿液中的sTREM-1水平在脓毒症诊断上优于CRP和PCT,血sTREM-1和尿sTREM-1水平是脓毒症患者预后的独立危险因素。Objective To evaluate the value of serum and urine sTREM-1 in the diagnosis and prognosis of patients with sepsis. Methods Eighty-four patients with systemic inflammatory response syndrome （SIRS）, who were admitted into intensive care unit, were divided into groups according to the infection status and survival situation in 28 days. Serum and urine levels of sTREM-I, and serum levels of PCT and CRP, and APACHE ]I score were recorded at 1 h after enrollment. Indicators to the diagnosis and prognosis were managed by receiver operating characteristic （ROC）. The risk factors were analyzed by univariate and multivariate Logistic regression analysis. Results Serum and urine levels of sTREM-1, and serum levels of PCT and CRP were increased in sepsis group. The area under ROC curve of the serum and urine levels of sTREM-1, and serum levels of PCT and CRP for the diagnosis of sepsis were 0.894, 0.800, 0.722 and 0.692. The APACHE ]I score, WBC, serum and urine levels of sTREM-1, serum levels of PCT and CRP were increased in death group at lb. Multivariate Logistic regression analysis showed that APACHE 1] score, serum and urine levels of sTREM-1 were independent risk factors for the prognosis of sepsis. Conclusion The values of serum and urine levels of sTREM-1 for the diagnosis of sepsis were better than those of serum levels of CRP and PCT, and were independent risk factors for sepsis.

关 键 词：脓毒症 可溶性髓样细胞触发受体-1 C-反应蛋白 降钙素原 

分 类 号：R459.7[医药卫生—急诊医学]