外周血sTREM-1、IL-6及CD11b、CD62L在呼吸机相关性肺炎诊断中的价值分析  

The value of sTREM-1,IL-6,CD11b and CD62L in the diagnosis of ventilator-associated pneumonia

作　　者：贾卉娟 邓蓉 张解放 李凡民[1] 孟鲁静 王东秋 王成敏 Jia Huijuan;Deng Rong;Zhang Jiefang;Li Fanmin;Meng Lujing;Wang Dongqiu;Wang Chengmin(Heavy Disease Medicine Department of Heze City Hospital,Heze 274700,China)

机构地区：[1]山东省菏泽市立医院重症医学科,山东菏泽274700

出　　处：《国际免疫学杂志》2020年第4期382-388,共7页International Journal of Immunology

摘　　要：目的探究外周血可溶性髓系细胞触发受体1(soluble myeloid cell triggering receptor 1,sTREM-1)、白细胞介素-6(interleukin-6,IL-6)及白细胞分化抗原11b(cluster of differentiation 11b,CD11b)、白细胞分化抗原62L(cluster of differentiation 62L,CD62L)在呼吸机相关性肺炎(ventilator associated pneumonia,VAP)诊断中的价值。方法选取山东省菏泽市立医院进行机械通气发生VAP的72例患者作为VAP组,另选取进行机械通气的56例非VAP患者作为对照组,采用酶联免疫吸附实验测定患者外周血中sTREM-1、IL-6水平,流式细胞术测定CD11b、CD62L,对比两组入院基本资料,统计VAP患者病原菌检出类型以及分布情况;比较两组患者外周血中sTREM-1、IL-6、CD11b、CD62L水平,创建受试者工作特征曲线(receiver operating characteristic curve,ROC),比较sTREM-1、IL-6、CD11b、CD62L曲线下面积(the area under the curve,AUC)。结果VAP组临床肺部感染评分(clinical pulmonary infection scoring,CPIS)、温度、外周血中C反应蛋白(C-reactive protein,CRP)、白细胞(white blood cell,WBC)均高于非VAP组,差异有统计学意义(t值分别为3.126、2.013、25.870、8.355,P值均<0.05)。VAP组患者培养出64株致病菌,其中革兰氏阴性菌50株,革兰氏阳性菌12株,真菌2株。VAP组外周血中sTREM-1、IL-6、CD11b、CD62L水平均高于非VAP组,差异有统计学意义(t值分别为6.458、10.804、5.466、20.465,P值均<0.05)。ROC曲线分析显示,外周血sTREM-1浓度118 pg/mL能够作为诊断VAP的最佳阈值,敏感度为75.68%,特异度为85.96%,AUC值最大为0.867,其诊断价值优于血清IL-6、CD11b、CD62L(线下面积分别为0.651、0.808和0.719)。结论外周血sTREM-1、IL-6及CD11b、CD62L在诊断VAP均有一定的价值,但sTREM-1诊断价值最高,可作为VAP疗效判定指标。Objective To explore the value of peripheral bloodSoluble myeloid cell triggering receptor 1(sTREM-1),interleukin-6(IL-6)and cluster of differentiation 11b(CD11b),cluster of differentiation 62L(CD62L)in diagnosis of ventilator associated pneumonia(VAP).Methods Total of 72 cases of patients with VAP occurred in mechanical ventilation in Heze City Hospital were selected as VAP group,and 56 cases of patients with non-VAP in mechanical ventilation were selected as the control group.sTREM-1and IL-6 levels in peripheral blood were tested by enzyme linked immunosorbent assay,CD11b and CD62L were tested by flow cytometry.The basic data of the two groups were compared,the detection types and distribution of pathogens in VAP patients were counted;the levels of sTREM-1,IL-6,CD11b,CD62L in peripheral blood were compared between the two groups.Receiver operating characteristic curve(ROC)was created,and the areas under the curve(AUC)of sTREM-1,IL-6,CD11b and CD62L were compared.Results The clinical pulmonary infection score(CPIS),temperature,C-reactive protein(CRP)and white blood cell(WBC)in VAP group were higher than those in non VAP group(t values were 3.126,2.013,25.870 and 8.355,respectively,all P values<0.05).In VAP group,64 strains of pathogenic bacteria were cultured,including 50 strains of Gram-negative bacteria,12 strains of Gram-positive bacteria and 2 strains of fungi.The levels of sTREM-1,IL-6,CD11b and CD62L in VAP group were significantly higher than those in non VAP group(t values were 6.458、10.804、5.466、20.465,respectively,all P values<0.05).ROC curve analysis showed that 118 pg/ml of sTREM-1 in peripheral blood could be used as the optimal threshold for the diagnosis of VAP,with a sensitivity of 75.68%,a specificity of 85.96%,and a maximum AUC of 0.867.The diagnostic value of sTREM-1 was better than that of serum IL-6,CD11b and CD62L(the area under the line were 0.651,0.808 and 0.719,respectively).Conclusion It has certain diagnostic value of peripheral blood sTREM-1,IL-6 and CD11b,CD62L in diagnosis of

关 键 词：呼吸机相关性肺炎 可溶性髓系细胞触发受体1 白细胞介素-6 白细胞分化抗原10 白细胞分化抗原62L 诊断价值 

分 类 号：R563.1[医药卫生—呼吸系统]