动态检测ICU重度腹部创伤患者外周血sCD14-T/mCD14水平的意义  

Significance of Dynamic Detection of sCD14-T/mCD14 Level in Peripheral Blood of ICU Patients with Severe Abdominal Trauma

作　　者：李智鑫[1] 应利君[1] 吕铁[1] 俞国峰[1] Li Zhixin;Ying Lijun;Lv Tie(Department of Intensive care Unit,Shaoxing People′s Hospital,Zhejiang 312000,China)

机构地区：[1]绍兴市人民医院重症医学科,312000

出　　处：《医学研究杂志》2021年第1期123-127,136,共6页Journal of Medical Research

基　　金：浙江省绍兴市科技计划(医卫类)项目(2018C30062)。

摘　　要：目的探讨外周血可溶性CD14分子亚型(sCD14-T)/膜结合CD14(mCD14)对腹部创伤并发脓毒症患者的早期诊断价值。方法前瞻性病例对照研究分析2017年6月~2019年12月笔者医院ICU收治的86例符合纳入标准的腹部创伤患者,根据其48h后是否并发脓毒症分为脓毒症组及非脓毒症组,选择30例胃大部切除术(为择期手术)后患者作为对照组,分别检测3组患者入科后0、24、48、72h外周血中sCD14-T/mCD14、sCD14-T、sTREM-1和PCT的水平,比较上述指标对创伤后并发脓毒症的早期诊断价值。结果随着时间推移,3组患者sCD14-T水平较入科时均上调,以脓毒症组上调幅度最大(P<0.01);在各时相点(0、24、48、72h)sCD14-T表达水平呈现为脓毒症组>非脓毒症组>对照组(P<0.01)。脓毒症组及非脓毒症组mCD14-T水平较入科时均下调,脓毒症组下调幅度大于非脓毒症组(P<0.01),在各时相点mCD14表达水平呈现为对照组>非脓毒症组>脓毒症组(P<0.01);脓毒症组及非脓毒症组sTREM-1、PCT水平较入科时均上调,上调幅度脓毒症组大于非脓毒症组(P<0.01);在各时相点sTREM-1、PCT表达水平呈现为脓毒症组>非脓毒症组>对照组(P<0.01)。sCD14-T/mCD14诊断腹部创伤后脓毒症的敏感度为84.6%,特异性为87.5%,ROC曲线下面积为0.895,明显优于sCD14-T、sTREM-1和PCT(P<0.05)。结论sCD14-T/mCD14是一种优于sCD14-T、sTREM-1及PCT早期诊断脓毒症的指标,可以提高腹部创伤患者脓毒症早期确诊率,为及早干预治疗赢得时间。Objective To investigate the value of sCD14-T/mCD14 in the early diagnosis of sepsis in patients with abdominal trauma.Methods It was a prospective case-control study.We analyzed 86 patients admitted to the intensive care unit of our hospital from June 2017 to December 2019 who met the inclusion criteria for abdominal trauma.They were divided into the sepsis group and the non-sepsis group according to whether it was complicated with sepsis after 48h.Thirty patients with subtotal gastrectomy(elective)were selected as the control group.The levels of sCD14-T/mCD14,scd14-t,strem-1 and PCT in peripheral blood of the 3 groups of patients were measured at 0,24,48 and 72 hours after admission,respectively.We compared the value of the above indicators in the early diagnosis of post-traumatic sepsis.Results With the passage of time,sCD14-T levels in the three groups were all up-regulated compared with the time of admission,and the sepsis group had the largest up-regulated range(P<0.01).At all time points(0h,24h,48h,72h),the expression level of sCD14-T was as follows:sepsis group>non-sepsis group>control group(P<0.01).Meanwhile,the level of mCD14 in both the sepsis group and the non-sepsis group was lower than that in the admission period,and the decrease of mCD14 in the sepsis group was greater than that in the non-sepsis group(P<0.01).At all time points,the expression level of mCD14 in peripheral blood of patients was as follows:control group>non-sepsis group>sepsis group(P<0.01).Meanwhile,the levels of sTREM-1 and PCT in both the sepsis group and the non-sepsis group were significantly higher than those in the non-sepsis group(P<0.01).At all time points,the expression levels of sTREM-1 and PCT was as follows:sepsis group>non-sepsis group>control group(P<0.01).The sensitivity,specificity and area under the ROC curve of sCD14-T/mCD14 in the diagnosis of abdominal post-traumatic sepsis were 84.6%,87.5%and 0.895,which were significantly better than sCD14-T,sTREM-1 and PCT(P<0.05).Conclusion sCD14-T/mCD14 is a better indicato

关 键 词：游离脂多糖受体 膜结合脂多糖受体 创伤脓毒症 诊断价值 

分 类 号：R5[医药卫生—内科学]