sTREM-1在钝性胸部外伤及合并肺挫伤中的动态变化及临床意义  

Dynamic changes and clinical significance of sTREM-1 in blunt chest trauma and pulmonary contusion

作　　者：陆志斌[1] 周存荣[1] 占根生 吴卫兵[2] 徐晓晗[2] 吴延虎[2] 

机构地区：[1]南京市浦口区中心医院胸心外科,南京211800 [2]江苏省人民医院胸心外科

出　　处：《山西医科大学学报》2015年第7期675-679,共5页Journal of Shanxi Medical University

基　　金：南京市科技计划资助项目(201303034)

摘　　要：目的探讨钝性胸部外伤及合并肺挫伤中s TREM-1、TNF-α及CRP的动态表达变化及其临床意义。方法选健康体检人群为对照组。用酶联免疫吸附试验(ELISA)法测定钝性胸部外伤无肺挫伤组(无肺挫伤组)、钝性胸部外伤合并肺挫伤组(肺挫伤组)及钝性胸部外伤合并肺挫伤者进展为ALI/ARDS组(ALI/ARDS组)血清中s TREM-1和TNF-α含量在患者入院时及入院后1,3,7 d的变化;同时用免疫比浊度法测定各组血清中CRP含量的动态变化。比较各组间的表达水平,并结合病程及病情变化进行分析。采用ROC曲线分析各个指标的敏感性及特异性。结果 sTREM-1在发生胸部外伤后均较对照组明显升高(P<0.05);病情越重升高越明显;各组在入院时表达最高,随着病程的延长逐渐降低。血清TNF-α的表达与血清s TREM-1有相同的统计学意义,但在无肺挫伤组的第7天可恢复至健康人群水平。随病程变化表现为先升高后降低,受伤后第1天达最高水平。而CRP对病情的评估只有在合并肺挫伤或更严重的ALI/ARDS才表现出差异性。ROC曲线分析:sTREM-1、TNF-α和CRP ROC的AUC分别为0.862, 0.839, 0.726。sTREM-1、TNF-α最佳阈值分别为96.8 pg/ml,249.6 pg/ml,诊断的灵敏度分别为95.0%,92.9%,特异度分别为77.3%,74.8%。结论血清中s TREM-1水平的表达在钝性胸外伤合并肺挫伤中显著增加,尤其是进展为ALI/ARDS者,其敏感性及特异性均较高,有望成为肺挫伤严重程度的独立评估指标,较TNF-α及CRP更有临床意义。Objective To investigate the dynamic changes and clinical significance of soluble triggering receptor expressed on myeloid cell-1 （sTREM-1）, tumor necrosis factor-alpha （TNF-α） and C-reactive protein（CRP） in patients with blunt chest trauma and pulmona- ry contusion. Methods The healthy examination sujects were chosen as control group. Enzyme linked immunosorbent assay（ELISA） was used to determine the value of sTREM-1 and TNF-α in patients with blunt chest trauma without pulmonary contusion, blunt chest trauma with pulmonary contusion, or blunt chest trauma with pulmonary contusion progressed to ALI/ARDS at 1, 3, 7 d after admis- sion. Meanwhile, the dynamic changes of serum CRP contents in each group were determined using immune turbidity. All the expres- sion levels were analyzed and compared according to the course and changes of the disease. And the sensitivity and specificity of each index were analyzed by ROC curve. Results The values of TREM-1 in the chest trauma patients were significantly higher than that in control group（P 〈0.05）. The severer the disease became,the higher the value was. The expression of sTREM-1 in each group was the highest at the admission, and then decreased. The expression of TNF-α had the same statistical significance with sTREM-1, but it recov- ered to the normal level at 7 d in blunt chest trauma without pulmonary contusion group. The levels of TNF-α increased at first and then decreased, and peaked at 1 d after injury. There was no statistical significance of the CRP except in patients with blunt chest trauma with pulmonary contusion or blunt chest trauma with pulmonary contusion progressed to ALI/ARDS. ROC curve analysis showed that ROC AUC of sTREM-1 ,TNF-α,CRP were 0. 862,0. 839,0. 726, respectively. The best thresholds of TNF-α and sTREM-1 were 96.8 pg/ml and 249.6 pg/ml, respectively, their sensitivities were 95% and 92.9%, and their specificities were 77.3% and 74.8%. Conclusion The expression of sTREM-1 after blunt chest trauma combined with pu

关 键 词：STREM-1 TNF-Α 肺挫伤 ALI/ARDS 

分 类 号：R641[医药卫生—外科学]