外周血PCTIL-17及sTREM-1检测在呼吸机相关性肺炎早期诊断中的价值  

The early diagnostic value of detecting the peripheral blood serum PCT, IL - 17, sTREM - 1 levels in the patients with VAP

作　　者：秦珊[1] 何先弟[1] 汪华学[1] 

机构地区：[1]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233004

出　　处：《中国急救医学》2017年第5期427-432,共6页Chinese Journal of Critical Care Medicine

基　　金：安徽省“十二五”临床重点培育专科建设项目（01P44）;安徽省科技攻关项目（1301042221）

摘　　要：目的检测机械通气并发生呼吸机相关性肺炎（VAP）患者外周血中降钙素原（PCT）、白细胞介素-17（IL-17）和可溶性髓样细胞触发受体-1（sTREM-1）水平，分别探讨外周血PCT、IL-17及sTREM-1水平对VAP的早期诊断价值。方法以蚌埠医学院第一附属医院ICU2015—04～2016—04间，行机械通气并发生VAP的61例患者作为研究对象，根据外周血采集时间分为三组：未行机械通气时作为机械通气0h组（MV0h）；行机械通气满48h，未发生VAP时作为机械通气48h组（MV48h）；确诊VAP患者作为VAP组，每组血清样本均采用ELISA测定PCT、IL-17和sTREM-1水平，数据采用SPSS18．0统计软件进行统计学分析。结果MV48h组血清样本中PCT、IL-17和sTREM-1水平高于MV0h组，差异无统计学意义（P〉0．05）。VAP组血清样本中PCT、IL-17和sTREM-1水平明显高于MV0h、MV48h组，差异均有统计学意义（P〈0．05）。血清PCT的受试者工作曲线（ROC曲线）下面积为0．856，当血清中PCT水平达到104．7864pg／mL时，早期诊断VAP的敏感度73．9％，特异度84．8％；血清IL-17的ROC曲线下面积为0．887，当血清中IL-17水平达到136．9726pg／mL时，早期诊断VAP的敏感度70．8％，特异度91．7％；血清sTREM-1的ROC曲线下面积为0．813，当血清中sTREM-1水平达到95．4204pg／mL时，早期诊断VAP的敏感度72．4％，特异度79．3％。结论患者外周血血清中PCT、IL-17和sTREM-1水平对VAP均具有一定的辅助诊断价值。Objective We detected the changes of peripheral blood serum procalcitonin （PCT） , IL - 17 and sTREM - 1 levels in patients receiving mechanical ventilation and being to be ventilator associated pneumonia （ VAP）, to explore the early diagnostic value of PCT, IL - 17 and sTREM -1 levels in patients with VAP. Methods During April 2015 to April 2016, we collected 61 patients receiving mechanical ventilation and being to be VAP as the research individuals in ICU of our hospital. According to the peripheral blood collection time, the researchers were divided into 3 groups： the cases without mechanical ventilation as the mechanical ventilation 0 h group （ MV 0 h） ; the cases with mechanical ventilation for 48 hours and not occurred VAP, as the mechanical ventilation 48 h group （ MV 48 h） ; once diagnosed, the cases were included into VAP group. PCT, IL - 17 and sTREM - 1 levels of each group were detected by ELISA method, and the data were statistically analyzed using SPSS 18.0 statistical software. Results The serum levels of PCT, IL - 17 and sTREM - 1 in the group of MV 48 h were higher than those in the group nf MV 0 h, but without statistical significance （P 〉0.05 ）. The serum levels of PCT, IL - 17 and sTREM - 1 of VAP group were significantly higher than those in the group of MV0 h, MV48 h （P〈0.05）. The area under theROC curve of PCT was 0. 856. When the serum PCT level reached 104. 7864 pg/mL, the sensitivity of the early diagnosis of VAP was 73.9% , and the specificity was 84.4%. The area under the ROC curve of IL - 17 was 0. 877. When the serum IL - 17 level reached 136. 9726 pg/mL, the sensitivity of the early diagnosis of VAP was 70.8% , and the specificity was 91.7%. The area under the ROC curve of sTREM - 1 was 0. 813. When the serum sTREM - 1 level reached 95. 4204 pg/mL, the sensitivity of the early diagnosis of VAP was 72.4% , and the specificity was 79.3%. Conclusion The peripheral blood serum PCT, IL - 17 and sTREM - 1 of in patients with VAP all have a certain diagnostic

关 键 词：呼吸机相关性肺炎(VAP) 降钙素原(PCT) 白细胞介素-17(IL-17) 可溶性髓样细胞触发受体-1(sTREM-1) 炎症因子 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]