可溶性髓样细胞触发受体-1在呼吸机相关性肺炎的早期诊断及预后评估中的临床应用  

Clinical value of soluble triggering receptor expressed on myeloid cells-1 in early diagnosis of ventilator-associated pneumonia and evaluation of prognosis

作　　者：陈少霖[1] 张卫星[1] 张声[1] 赖剑波[2] 陈兴旺[2] 黄静[3] 

机构地区：[1]北京大学深圳医院ICU,广东深圳518000 [2]广州医科大学深圳沙井医院ICU,广东深圳518148 [3]中山大学附属第三医院呼吸内科,广东广州510630

出　　处：《中华医院感染学杂志》2017年第13期2968-2971,共4页Chinese Journal of Nosocomiology

基　　金：深圳市卫计委科研基金资助项目(201506043)

摘　　要：目的探讨可溶性髓样细胞触发受体-1(sTREM-1)在呼吸机相关性肺炎(VAP)患者早期诊断及预后评估的临床应用价值。方法收集2014年1月-2016年10月患者60例,分为VAP组(26例)、非VAP组(34例);另选30名健康志愿者为对照组;在VAP组中根据其28天存活与否分成生存组与死亡组;收集患者机械通气第1、3、5、7天血清和肺泡灌洗液标本,分别检测sTREM-1,血清降钙素原(PCT),血清C-反应蛋白(CRP);采用受试者工作特征(ROC)曲线分析血清CRP、PCT、sTREM-1和灌洗液sTREM-1对VAP的早期诊断价值;应用Logistic回归分析影响VAP患者预后的危险因素。结果 VAP发病率为43.33%,而VAP组28天死亡率高达46.15%;APACHEII评分和28天死亡率,VAP组较非VAP组显著升高(P<0.05);气管插管时间、机械通气时间、和ICU住院时间,VAP组较非VAP组的时间显著延长(P<0.01);ROC曲线分析CRP、CPT、sTREM-1水平对VAP早期诊断的意义;血清sTREM-1的AUC为0.73;敏感性是0.73,特异性是0.69,(95%CI:0.58~0.88);支气管肺泡灌液sTREM-1的AUC为0.90;敏感性是0.88,特异性是0.82,(95%CI:0.85~0.98)。28天死亡组(12例)的APACHE II评分、血清CRP、血清PCT、血清sTREM-1和灌洗液中sTREM-1均高于生存组(14例),多因素logistic回归分析后,其中支气管肺泡灌洗液中sTREM-1水平及APACHE II评分为预后独立危险因素(P<0.05)。结论支气管肺泡灌洗液sTREM-1可作为VAP早期诊断指标,其敏感性及特异性高于血清CRP、PCT、sTREM-1,而且其水平与APACHE II评分均可评估VAP预后。OBJECTIVE To explore the clinical value of soluble triggering receptor expressed on myeloid cells-1（sTREM-1）in early diagnosis of ventilator-associated pneumonia（VAP）and evaluation of prognosis.METHODS A total of 60 patients who were treated in hospitals from Jan 2014 to Oct 2016 were enrolled in the study and divided into the VAP group with 26 cases and the non-VAP group with 34 cases.30 healthy volunteers were set as the control group.The patients in the VAP group were divided into the survival group and the death group according to the 28-day survival status.The serum and bronchoalveolar lavage fluid（BALF）specimens were collected from the patients on Day 1,3,5,and 7 of mechanical ventilation so as to detect sTREM-1,serum procalcitonin（PCT）,and serum C-reactive protein（CRP）.The value of serum CRP,PCT,sTREM-1,and BALF sTREM-1 in early diagnosis of VAP was analyzed by means of receiver-operating-characteristic（ROC）curve;the logisticregression analysis was performed for the risk factors for prognosis of the patients with VAP.RESULTS The morbidity rate of VAP was 43.33%,however,the 28-day mortality rate of the VAP group was 46.15%.The APACHEII score and 28-day mortality rate were significantly higher in the VAP group than in the non-VAP group（P〈0.05）.The endotracheal intubation time,mechanical ventilation duration,and length of ICU stay were significantly longer in the VAP group than in the non-VAP group（P〈0.01）.The ROC curve analysis showed that the levels of CRP,CPT,and sTREM-1 had significance in early diagnosis of VAP;the AUC of the serum sTREM-1 was 0.73,the sensitivity 0.73,the specificity 0.69（95% CI：0.58-0.88）;the AUC of the BALF sTREM-1 was 0.90,the sensitivity 0.88,the specificity 0.82,（95% CI：0.85~0.98）.The APACHE II score and levels of serum CRP,serum PCT,serum sTREM-1,and BALF sTREM-1 were higher in the 28-day death group（12 cases）than in the survival group（14 cases）.The multivariate logisticregression analysis indicated that the BALF sTREM-1 leve

关 键 词：可溶性髓样细胞触发受体-1、呼吸机相关性肺炎、支气管肺泡灌洗液 早期诊断、预后评估 

分 类 号：R563.1[医药卫生—呼吸系统]