PCT、TREM-1联合CPIS评分对新生儿呼吸机相关性肺炎的早期诊断价值研究  

Clinical value of the combination of procalcitonin and triggering receptor expressed on myeloid cells-1 and clinical pulmonary infection score for the early diagnosis of ventilator-associated pneumonia in neonates

作　　者：朱红玲[1] 钱颖[1] 陈淑芳[1] 陈妍[1] 吴跃军[1] 

机构地区：[1]浙江省金华市人民医院,浙江金华321000

出　　处：《中国妇幼健康研究》2016年第3期340-342,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨降钙素原(PCT)、髓系细胞表达的触发受体-1(TREM-1)联合肺部感染评分(CPIS)评分对新生儿呼吸机相关性肺炎(VAP)早期诊断的临床价值。方法以88例有创机械通气患儿作为研究对象,所有患儿均在机械通气后第1天、第3天、第7天采集外周血及肺泡灌洗液标本并进行检测,同时进行CPIS评分,根据治疗后评估,将88例患儿分为VAP组(46例)与非VAP组(42例),应用ROC曲线评价PCT、TREM-1、CPIS联合指标对VAP的早期诊断价值。结果两组的PCT(第1天:0.53±0.15ng/mL vs 0.36±0.12ng/mL;第3天:2.07±1.22ng/mL vs 0.45±0.13ng/mL;第7天:2.54±1.31ng/mL vs 0.47±0.12ng/mL)、TREM-1(第1天:4.18±1.17pg/mL vs 3.01±0.78pg/mL;第3天:3.01±0.78pg/mL vs 3.52±0.85pg/mL;第7天:9.62±1.93pg/mL vs 4.03±1.14pg/mL)、CPIS评分(第1天:4.2±1.1分vs3.4±1.2分;第3天:5.2±0.9分vs 3.3±1.1分;第7天:5.5±1.2分vs 3.6±1.4分)差异有统计学意义(PCT:t值分别为-5.369、-7.583、-9.034;TREM-1;t值分别为-4.985、-7.370、-14.834;CPIS评分:t值分别为-3.053、-8.381、-6.437;均P<0.01)。第3天指标的诊断效能最高,PCT、TREM-1、CPIS评分联合指标对诊断VAP的敏感性、特异性、阳性预测值、阴性预测值分别80.4%、100.0%、93.5%、100.0%。结论结合PCT、TREM-1、CPIS评分综合分析,可以显著提高诊断的特异性,对新生儿VAP的早期诊断有较好的实用性。Objective To explore the clinical value of procalcitonin （PCT） and triggering receptor expressed on myeloid cells-1 （TREM- 1 ）, combed with clinical pulmonary infection score （CPIS） for the early diagnosis of ventilator-associated pneumonia （VAP） in neonates. Methods A total of 88 infant patients with invasive mechanical ventilation were chosen as research objects. Peripheral blood and bronchoalveolar lavage fluid of all those patients were collected and tested on the first, third and seventh day after receiving mechanical ventilation. All subjects were divided into VAP group （46 cases） and Non-VAP group （42 cases）. The clinic value of PCT, TREM-1, combed with CPIS for the early diagnosis of VAP was assessed by using receiver operating characteristic curve （ ROC ） curve analysis. Results There was significant differences in PCT （ dayl ： 0.53 ± 0.15ng/mL vs 0.36 ±0.12ng/mL ; day3 ： 2.07 ±1.22 ng/mL vs 0.45 ±0.13 ng/mL; day7 ： 2.54 ±1.31 ng/mL vs 0.47 ±0.12ng/mL）, TREM-1 （dayl ： 4.18 ±1.17pg/mL vs 3.01 ±0.78pg/mL; day3 ： 3.01 ±0.78pg/mL vs 3.52 ＋0.85pg/mL; day7：9.62 ±1.93pg/mL vs 4.03 ±1.14pg/mL） and CPIS （dayl ： 4.2 ±1.1 vs 3.4 ±1.2; day3： 5.2 ±0.9 vs 3.3 ＋ 1.1 ; day7 ： 5.5 ±1.2 vs 3.6 ±1.4） between the VAP group and Non-VAP group （ tpcT value was - 5. 369, - 7. 583 and -9.034, respectively; tTREM-1 value was - 4. 985, - 7. 370 and - 14. 834, respectively; tcpls value was - 3. 053, - 8. 381 and -6. 437, respectively, all P 〈 0.01 ）. On the third day, the diagnostic efficiency of those indicators reached its peak. ROC results showed that the sensitivity, specificity, positive predictive rates and negative predictive rates of the combined indicators of PCT, TREM-1 and CPIS for the diagnosis of VAP were 80.4% , 100.0% , 93.5% and 100.0% , respectively. Conclusion The comprehensive analysis on the combined indicators of PCT, TREM-1 and CPIS shows that these indicators can significantly improve the specificity of diagnosis, which is of

关 键 词：新生儿 降钙素原 髓系细胞表达的触发受体-1 肺部感染评分 呼吸机相关性肺炎 

分 类 号：R725.631[医药卫生—儿科]