可溶性髓样细胞触发受体-1对呼吸机相关性肺炎评估的价值  

The value of soluble triggering receptor expressed on myeloid cells-1 in the severity assessment of ventilator associated pneumonia

作　　者：陈月馨 郭琦[2] 张贵昌[3] 黄晨达[4] 

机构地区：[1]深圳市第四人民医院康复医学科,广东深圳518033 [2]深圳市第四人民医院呼吸科,广东深圳518033 [3]深圳市第四人民医院急诊科,广东深圳518033 [4]深圳市第四人民医院重症医学科,广东深圳518033

出　　处：《热带医学杂志》2014年第10期1321-1323,1366,共4页Journal of Tropical Medicine

基　　金：深圳市福田区公益性科研项目(FTWS201122)

摘　　要：目的探讨血浆中可溶性髓样细胞触发受体-1(s TREM-1)对呼吸机相关性肺炎(VAP)诊断和病情评估的意义。方法测定15例VAP患者(VAP组)和14例接受机械通气但无VAP的患者(非VAP组)血浆s TREM-1、降钙素原(PCT)、白介素-6(IL-6)浓度,分析s TREM-1与PCT、IL-6、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性,应用受试者工作特征(ROC)曲线分析诊断的敏感度与特异度。结果 VAP组血浆s TREM-1水平明显高于非VAP组[(0.835±0.700)ng/L vs(0.388±0.188)ng/L,P<0.05],而两组间PCT[(1.723±0.421)ng/L vs(1.771±0.343)ng/L]和IL-6[(1.510±0.362)ng/L vs(1.508±0.333)ng/L]差异无统计学意义。VAP组s TREM-1与IL-6、APACHEⅡ评分呈显著相关性(r=0.521、0.663,P<0.05)。血浆s TREM-1诊断呼吸机相关性肺炎的ROC曲线下面积为0.71,以0.864 ng/L为诊断浓度阈值,s TREM-1诊断VAP的特异性为100.0%。结论血浆s TREM-1在VAP诊断中特异性高,对评估VAP疾病严重程度有重要意义。Objective To evaluate the clinical value of soluble triggering receptor expressed on myeloid cells-1（s TREM-1）for early diagnosis and assessment of severity in ventilator associated pneumonia. Methods Plasma levels of s TREM-1,procalcitonin（PCT）, and interleukin（IL）-6 were examined in 15 patients with VAP（VAP group）, and in 14 patients underwent ventilation without VAP（ non-VAP group）. The correlation between s TREM-1, PCT, IL-6, acute physiology and chronic health evaluation（APACHE） Ⅱ score in VAP group. The sensitivity and specificity of each parameter were calculated by the receiver operating characteristic（ROC） analysis. Results In the patients with VAP, s TREM-1 in plasma were significantly higher than that in the non-VAP group [（0.835±0.700）ng / L vs（0.388±0.188） ng / L, P0.05]; however, no other significant differences were observed among the two groups ： the levels of PCT [（1.723 ±0.421）ng / L vs（1.771 ±0.343）ng / L] or IL-6[（1.51±0.362）ng / L vs（1.508±0.333）ng / L]. The APACHEⅡ score of VAP group was（25.0±7.60） significantly higher than that（14.4±5.38） of the non-VAP group, P0.05. s TREM-1 is strongly correlated with APACHE Ⅱscore and IL-6; r is 0.663 and 0.521 respectively, P0.05. By ROC analysis, the area under ROC curve of s TREM-1 was 0.71.The cut-off value of s TREM-1 in plasma was 0.864 ng / L, with specificity of 100.0%. Conclusion s TREM-1 may be a useful marker in early diagnosis and assessment of severity of ventilator associated pneumonia.

关 键 词：呼吸机相关性肺炎 可溶性髓样细胞触发受体-1 降钙素原 IL-6 

分 类 号：R563.1[医药卫生—呼吸系统]