血清髓系细胞表达触发受体1水平在老年脓毒症合并急性呼吸窘迫综合征患者中的变化及其对预后的影响  

The influence of serum triggering receptor expressed on myeloid cells 1 level on prognosis in elderly patients with sepsis and acute respiratory distress syndrome

作　　者：杨建萍[1] 范华[2] 李雯[3] 姚尧[1] 沈美佳 张留伟[5] 任晓霞 张洪波[1] Yang Jianping;Fan Hua;Li Wen;Yao Yao;Shen Meijia;Zhang Liuwei;Ren Xiaoia;Zhang Hongbo(Departmentof Emergency,China-Japan Friendship Hospital,Beijing 100029,China;Department of Out-Patient and Emergency Departments of Pediatrics,China-Japan Friendship Hospital,Beijing 100029,China;Department of Intensive Care Unit(ICU),China-Japan Friendship Hospital,Beijing 100029,China;Department of Emergency Surgery,Shaanzi Provincial People's Hospital,Xi'an 710068,China;Sport Science College,Beijing Sport University,Beijing 100084,China;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]卫建委中日友好医院急诊科,北京100029 [2]卫建委中日友好医院儿科门急诊,北京100029 [3]卫建委中日友好医院重症医学科,北京100029 [4]陕西省人民医院急诊外科,北京710068 [5]北京体育大学运动人体科学学院,北京100091 [6]中日友好医院呼吸中心呼吸与危重症医学科,北京100029

出　　处：《中华老年医学杂志》2023年第6期715-719,共5页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费资助;中日友好医院“菁英计划”人才培育工程(ZRJY2021-TD02)。

摘　　要：目的探讨血清髓系细胞表达触发受体1(TREM-1)水平在老年脓毒症合并急性呼吸窘迫综合征(ARDS)患者中的变化及其对预后的影响。方法选取100例老年脓毒症患者作为研究对象,将全部脓毒症患者根据是否合并急性呼吸窘迫综合征(ARDS)分为脓毒症非ARDS患者组和脓毒症ARDS患者组,比较两组患者的一般资料和TREM-1水平。根据脓毒症ARDS患者的28d随访期间的生存状况分为死亡组和生存组,比较两组患者的TREM-1水平、急性生理与慢性健康状况(APACHEⅡ)评分和序贯器官衰竭评分(SOFA)评分,分析血清TREM-1水平与降钙素原(PCT)、APACHEⅡ评分和SOFA评分的相关性,比较高TREM-1水平组和低TREM-1水平组的生存率,以及对脓毒症ARDS患者预后的影响。结果脓毒症ARDS患者的年龄、白细胞(WBC)、降钙素原(PCT)、APACHEⅡ评分、SOFA评分和TREM-1水平显著高于非ARDS患者(t=2.722、6.088、11.550、6.889、4.661,6.122,均P<0.05)。脓毒症ARDS患者合并慢性阻塞性肺疾病的发生率显著高于非ARDS患者(χ^(2)=7.895,P=0.005)。死亡组ARDS患者的TREM-1、APACHEⅡ评分和SOFA评分显著高于生存组(t=3.293,6.173,4.255,均P<0.05)。血清TREM-1水平与PCT、APACHE Ⅱ评分和SOFA评分均呈正相关关系(r=0.553,0.602,0.636,均P<0.001)。Kaplan-Meier生存曲线结果显示高TREM-1水平组的生存率显著低于低TREM-1水平组(χ^(2)=3.999,P=0.036)。Cox回归分析结果显示,TREM-1水平是影响脓毒症ARDS患者预后的危险因素(HR=1.893、95%CI:1.049~3.414)。结论血清TREM-1水平在老年脓毒症ARDS患者中的表达显著升高,与其预后密切相关,是影响脓毒症ARDS患者预后的危险因素。Objective To study the influence of serum triggering receptor expressed on myeloid cells 1(TREM-1)level on prognosis in elderly patients with sepsis and acute respiratory distress syndrome(ARDS).Methods A total of 1oo elderly patients with sepsis were selected as the research objects.All the patients with sepsis were divided into sepsis ARDS group and sepsis non-ARDS group.General data and TREM-1 level were compared between the two groups.The patients with sepsis ARDS were divided into death group and survival group according to the survival status during the 28-day follow-up.TREM-1 level,acute physiology and chronic health evaluation(APACHE)Ⅱ score and SOFA score were compared between the two groups.The correlation between serum TREM-1 level and procalcitonin(PCT),APACHEⅡ score and SOFA score was analyzed.The survival rate of high TREM-1 level group and low TREM-1 level group was compared.Results The age,white blood cell(WBC),PCT,APACHEⅡ score,SOFA score and TREM-1 level of sepsis ARDS patients were significantly higher than those of non-ARDS patients(t=2.722,6.088,11.55,6.889,4.661,6.122,all P<0.05).The incidence of sepsis ARDS patients with chronic obstructive pulmonary disease was significantly higher than that of non-ARDS patients(χ^(2)=7.895,P<0.05).Serum TREM-1 level,APACHEⅡ score and SOFA score of ARDS patients in death group were significantly higher than those in survival group(t=3.293,6.173,4.255,all P<0.05).Serum TREM-1 level was positively correlated with PCT,APACHEⅡ score and SOFA score(t=0.553,0.602,0.636,P<0.001).The Kaplan-Meier survival curve showed that the survival rate of high TREM-1 level group was significantly lower than that of low TREM-1 level group(χ^(2)=3.999,P=0.036).Cox regression analysis showed that TREM-1 level was a risk factor for the prognosis of ARDS patients with sepsis(HR=1.893,95%CI:1.049-3.414).Conclusions Serum TREM-1 level is significantly increased in elderly patients with sepsis ARDS,which is closely related to the prognosis and can be used as a potential p

关 键 词：髓系细胞 脓毒症 呼吸窘迫综合征 预后 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]