对可溶性TOLL样受体2判断脓毒症患者血流感染病原菌临床价值的研究  

The study of clinical value of sTLR2 in identifying the pathogen of bloodstream infections in septic patients

作　　者：路玲[1] 王勇强[1] 李寅[1] 窦琳[1] 高红梅[1] 

机构地区：[1]天津市第一中心医院ICU,天津300192

出　　处：《中华急诊医学杂志》2016年第4期418-422,共5页Chinese Journal of Emergency Medicine

基　　金：天津市卫生局攻关课题（2010KG103）;国家临床重点专科建设项目

摘　　要：目的为脓毒症菌血症患者寻求可指导病原菌的标记物，以指导早期抗生素的合理使用。方法前瞻性观察天津市第一中心医院ICU 2012年8月至2015年3月的脓毒症患者147例，记录入住ICU确诊为脓毒症且血培养阳性时的常规检查：年龄、性别、生命体征、血常规、尿常规、便常规、出凝血项、血生化、 C反应蛋白（CRP）、降钙素原（PCT）、（1，3）-β-葡聚糖等，留取中心外周血培养， ELISA法测定可溶性TOLL样受体2（ sTLR2）及白细胞介素-8（ IL-8）表达量，计算急性生理学及慢性健康状况评分Ⅱ（ APACHEⅡ评分）等。计量资料假设检验采用单因素方差分析，计数资料采用χ2检验，绘制ROC曲线（受试者工作特征曲线）判断特异度和敏感度，以P＜0.05为差异具有统计学意义。结果依据血培养结果分为3组： GP组[革兰阳性（ G＋）球菌组]、 GN组[革兰阴性（ G-）杆菌]组、 FG组（真菌组），3组患者年龄、 APACHEⅡ评分、生命体征指标和炎性指标体温、白细胞等基线水平相比，在血培养阳性时差异无统计学意义（P＞0.05），所得结果亦显示本科致病菌以阴性菌为最常见。 sTLR2的表达量在GP组与GN组中相比，在GP组中的表达量明显高于GN组，且差异具有统计学意义， P＝0.000； sTLR2的表达量在在GP组与FG组中相比，差异无统计学意义， P＝0.187，但（1，3）-β-葡聚糖的表达量在 FG 组明显高于GP 组，且差异具有统计学意义，P＝0.000； sTLR2的表达量在GN组与FG组中相比， FG组中的表达明显高于GN组，且差异具有统计学意义，P＝0.000。 PCT、 CRP及IL-8在三组患者中两两比较差异无统计学意义（ P＞0.05）。诊断阴性菌感染时， sTLR2的曲线下面积为0.768，敏感度及特异度依次为88.90％及59.60％，最佳截断点为8.083 pg／mL，即sTLR2表达量高于8.083 pg／mL时，阴性菌感染的可能性较小，G＋Objective To search specific biomarkers of pathogenic bacteria in patients with sepsis so as to guide early using rationally antibiotic treatment.Methods Prospective survey of 147 patients with sepsis in ICU was carried out from Jan 2012 to Mar 2015.When patients blood culture was positive, clinical data including age, gender, vital signs, blood and, urine routine examination, DIC, blood biochemistry, c-reactive protein （CRP）, procalcitonin （PCT）, microbial detection, etc were recorded.Cultured blood samples were from central venous catheter and peripheral vessel.ELISA method was employed to detect soluble toll-like receptor 2 （ sTLR2 ） and interleukin-8 （ IL-8 ） , and the Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHEⅡ score ） was calculated.The chi-square test and analysis of variance were performed where necessary.Receiver operating characteristic （ ROC ） curves were used to calculate cut-points （ CP ） and area under the curve （ AUC） .Results According to the results of blood culture, patients were divided into three groups：GP group [ gram-positive bacteria （ G＋） group];GN group [ gram-negative bacteria （ G-） group];FG group （ fungi group） .There were no significantly statistical differences in age, APACHEⅡ score, vital signs and markers of inflammation among three groups （P〉0.05）.Gram negative pathogenic bacterium was the most common microbe.Compared with GN group, the level of sTLR2 in the GP group was obviously higher （ P=0.000）; but there was no significant difference in sTLR2 level between GP group and FG group （P=0.187）. The amount of （1, 3） -beta glucan in the FG group was significantly higher than that in the GP group （ P=0.000）.The sTLR2 level in FG group was obviously higher than that in the GN group （P=0.000）.There were no significantly statistical differences in PCT, CRP and IL-8 among the three groups （P〉0.05）.For the diagnosis of gram negative bacteria infection, sTLR2 area under the curve was 0.768, a

关 键 词：脓毒症 血流感染 炎性标记物 可溶性TOLL样受体2 (1  3) -β-葡聚糖 降钙素原 C-反应蛋白 

分 类 号：R459.7[医药卫生—急诊医学]