血清模式识别受体表达水平联合检测对血流感染脓毒症的诊断价值  

Diagnostic value of combined detection of serum pattern recognition receptors expression levels on blood stream infection sepsis

作　　者：张志斌[1] 王楚 韩英 王佳[1] 吕骏卿 林雪容 苑萌 韩树池[1] ZHANG Zhibin;WANG Chu;HAN Ying;WANG Jia;LYU Junqing;LIN Xuerong;YUAN Meng;HAN Shuchi(Emergency Department,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院急诊科,河北张家口075000

出　　处：《安徽医学》2023年第9期1055-1059,共5页Anhui Medical Journal

基　　金：2021年度张家口市市级科技计划自筹经费项目(编号:2121120D)。

摘　　要：目的探讨血清模式识别受体表达水平联合检测对血流感染(BSI)脓毒症的诊断价值。方法选择2021年1月至2022年7月河北北方学院附属第一医院收治的242例脓毒症患者,抗感染治疗前检测血清模式识别受体Toll样受体2(TLR2)、Toll样受体4(TLR4)、NOD样受体蛋白3(NLRP3)水平,进行血培养,并根据结果将入组患者分为BSI组(n=178)和非BSI组(n=64),将BIS组分为革兰氏阳性菌(G+)感染者(n=65)和革兰氏阴性菌(G-)感染(n=113)者。采用受试者工作特征(ROC)曲线分析血清TLR2、TLR4、NLRP3水平对BSI的诊断价值。结果BSI组患者血清TLR2水平为(8.37±1.46)pg/mL、TLR4为(11.25±2.21)pg/mL、NLRP3为(766.97±150.08)ng/mL,均高于非BSI组,差异有统计学意义(P<0.05);BSI组中,G-患者的血清TLR2水平为(8.92±1.41)pg/mL、TLR4为(11.86±2.07)pg/mL、NLRP3为(824.39±129.43)ng/mL,均高于G+患者,差异有统计学意义(P<0.05);两组患者血清TLR2、TLR4、NLRP3水平均与APACHE II评分、SOFA评分呈正相关;血清TLR2、TLR4、NLRP3单独诊断BSI脓毒症的曲线下面积(AUC)分别为0.857、0.789和0.753,三指标联合的AUC为0.934,灵敏度、特异度分别为90.63%和87.08%;血清TLR2、TLR4、NLRP3单独诊断BSI脓毒症患者G-感染的AUC分别为0.780、0.722和0.816,三指标联合的AUC为0.900,灵敏度、特异度分别为82.46%和83.08%。结论血清TLR2、TLR4、NLRP3在诊断BSI脓毒症及细菌感染类型中具有一定的参考意义。Objective To study the diagnostic value of combined detection of serum pattern recognition receptor expression level on blood stream infection(BSI)sepsis.Methods A total of 242 patients with sepsis admitted from January 2021 to July 2022 in the First Affiliated Hospital of Hebei North University were selected as subjects.Before anti infection therapy,the levels of toll like receptor 2(TLR2),toll like receptor 4(TLR4),and NOD-like receptor protein 3(NLRP3)in serum were detected,and blood culture was conducted.The patients were divided into BSI group(n=178)and non BSI group(n=64)according to the blood culture results,and BIS group was divided into patients with Gram positive bacteria(G+)infection(n=65)and patients with Gram negative bacteria(G-)infection(n=113).The diagnostic value of serum TLR2,TLR4,and NLRP3 levels for BSI was analyzed by the receiver operating characteristic(ROC)curve.Results The serum TLR2(8.37±1.46)pg/mL,TLR4(11.25±2.21)pg/mL,NLRP3(766.97±150.08)ng/mL levels in BSI group were higher than(6.49±0.75)pg/mL,(8.78±2.10)pg/mL,(619.65±150.33)ng/mL in non BSI group(P<0.05).The serum TLR2(8.92±1.41)pg/mL,TLR4(11.86±2.07)pg/mL,NLRP3(824.39±129.43)ng/mL levels of G-patients were higher than(7.40±1.44)pg/mL,(10.19±1.93)pg/mL,(667.15±119.94)ng/mL of G+patients in BSI group(P<0.05).The serum TLR2,TLR4 and NLRP3 levels in BSI group and non BSI group were positively correlated with APACHE II score and SOFA score.The AUC of serum TLR2,TLR4,NLRP3 in the diagnosis of BSI sepsis was 0.857,0.789,0.75,respectively,and the AUC of the three indicators in combination was 0.934,the sensitivity and specificity of the combination of three indicators was 90.63%and 87.08%respectively.The AUC of serum TLR2,TLR4,NLRP3 in the diagnosis of G-infection in BSI sepsis was 0.780,0.722,0.816,respectively,and the AUC of the three indicators in combination was 0.934,the sensitivity and specificity of the combination of three indicators was 82.46%and 83.08%respectively.Conclusions The combined detection of serum TLR2,TLR4

关 键 词：脓毒症 血流感染 模式识别受体 革兰氏阴性菌 诊断 

分 类 号：R459.7[医药卫生—急诊医学]