血清可溶性髓样细胞触发受体-1对重症脓毒症患者预后判断价值  

Value of serum soluble triggering receptor expressed on myeloid cell-1 in prognosis of patients with severe sepsis

作　　者：潘定康 陈怿 段鹏凯[3] 安晓庆[3] 童华生[3] 

机构地区：[1]解放军173医院急诊科,广东惠州516001 [2]东莞太平人民医院重症医学科,广东东莞523907 [3]广州军区广州总医院全军热区创伤救治与组织修复重点实验室,广州510010

出　　处：《第三军医大学学报》2016年第8期845-849,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81471839)~~

摘　　要：目的研究血清可溶性髓样细胞触发受体-1(s TREM-1)浓度检测对重症脓毒症患者预后的判断价值。方法回顾性分析重症脓毒症患者共83例,根据28 d死亡结局分为存活组(n=63)和死亡组(n=20),比较2组患者在基本情况、入院24 h APACHEⅡ评分最高值、全血C反应蛋白(C-reactive protein,CRP)和乳酸(lactate,Lac)浓度、血清降钙素(procalcitonin,PCT)和s TREM-1浓度等方面的差异,并绘制ROC曲线分析相关指标对疾病的预后判断及诊断价值,多因素Logistic回归分析探讨与疾病死亡相关的危险因素。结果 2组患者基本情况差异无统计学意义(P>0.05)。死亡组患者在APACHEⅡ评分最高值和血清s TREM-1浓度上要高于存活组(P<0.05),而在血清PCT、全血CRP和Lac浓度上2组间比较,则差异无统计学意义(P>0.05)。ROC曲线分析结果表明,血清s TREM-1浓度对重症脓毒症患者死亡预测的曲线下面积为0.77。多因素Logistic回归分析结果显示,APACHEⅡ评分和血清s TREM-1浓度是重症脓毒症患者死亡的独立高危因素。结论血清s TREM-1浓度有望成为预测重症脓毒症患者预后的可靠指标,也可能是重症脓毒症患者死亡的独立危险因素。Objective To investigate the value of serum soluble triggering receptor expressed on myeloid cell-1（ s TREM-1） in the prognosis of patients with severe sepsis. Methods Eight-three patients with severe sepsis were involved in the retrospective study. They were divided into survivor group（ n = 63）and non-survivor group（ n = 20） according to 28-day mortality. Baseline indexes,APACHE Ⅱ peak score,serum concentrations of s TREM-1 and procalcitonin（ PCT）,and whole blood levels of C-reactive protein（ CRP） and lactate（ Lac） were recorded within 24 h after admission,and the differences of above indicators were analyzed. The above indicators in the prognosis was tested by receiver operator characteristic（ ROC）curve. Multivariate logistic regression analysis was performed to evaluate the risk factors. Results There was no significant differences in the baseline indexes between the 2 groups（ P〉0. 05）. The serum concentration of s TREM-1 and APACHE Ⅱ peak score in the survivors were significantly higher than those in the nonsurvivors（ P〈0. 05）. But no significant differences were observed in the serum PCT and blood CRP and Lac（ P〉0. 05）. The area under ROC curve of serum concentration of s TREM-1 was 0. 770. Multivariate logistic regression analysis showed that APACHEⅡ score and serum concentration of s TREM-1 were independent risk factors for the prognosis of severe sepsis. Conclusion The serum concentration of s TREM-1 might be a reliable indicator and independent risk factor for the prognosis of patients with severe sepsis.

关 键 词：重症脓毒症 可溶性髓样细胞触发受体-1 急性生理学和慢性健康评估Ⅱ 预后 

分 类 号：R392.11[医药卫生—免疫学] R446.11[医药卫生—基础医学]