出血性脑卒中患者微创血肿引流术后肺部感染TLR4和TREM1及其预测价值  

Serum TLR4,TREM1 in hemorrhagic stroke patients after minimally invasive hematoma drainage and their predictive value for pulmonary infection

作　　者：何红梅 鲍丽云 梁瑞嘉 蒋争争 王贤德 HE Hong-mei;BAO Li-yun;LIANG Rui-jia;JIANG Zheng-zheng;WANG Xian-de(Lin'an District First People's Hospital,Hangzhou,Zhejiang 31l300,China)

机构地区：[1]杭州市临安区第一人民医院神经外科,浙江杭州311300 [2]杭州市临安区第一人民医院护理部,浙江杭州311300 [3]杭州市临安区第一人民医院康复科,浙江杭州311300

出　　处：《中华医院感染学杂志》2024年第23期3586-3590,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2023XY150)。

摘　　要：目的探讨出血性脑卒中患者微创血肿引流术后肺部感染Toll样受体4(TLR4)、髓样细胞触发受体1(TREM1)及其预测价值。方法选取2021年1月—2023年12月杭州市临安区第一人民医院神经外科行微创血肿引流术的110例出血性脑卒中患者,根据微创血肿引流术后肺部感染情况分为感染组27例和非感染组83例;采集患者痰液,进行病原菌分离鉴定;采用酶联免疫法检测患者术后24 h内血清TLR4、接头分子髓样分化初级应答基因88(MyD88)和TREM1水平;Pearson相关性分析出血性脑卒中患者血清TLR4、TREM1、MyD88的关系;采用受试者工作特征(ROC)曲线分析血清TLR4、TREM1对出血性脑卒中患者微创血肿引流术后肺部感染的预测价值。结果出血性脑卒中患者微创血肿引流术后肺部感染发生率为24.54%(27/110),共培养分离病原菌34株,以肺炎克雷伯菌(29.41%)和铜绿假单胞菌(17.65%)为主;感染组血清TLR4、TREM1和MyD88分别为(17.32±4.28)μg/L、(352.69±83.45)ng/L和(3.78±0.42)ng/L,高于非感染组(P<0.05);出血性脑卒中患者血清TLR4与TREM1、MyD88均呈正相关(r=0.791,0.869,P均<0.001),TREM1与MyD88呈正相关(r=0.784,P<0.001);术前血清TLR4、TREM1单独及联合预测出血性脑卒中微创血肿引流术后肺部感染发生的曲线下面积(AUC)分别为0.839、0.826和0.916。结论TLR4、TREM1在出血性脑卒中微创血肿引流术后肺部感染患者血清中异常升高,术前血清TLR4、TREM1联合检测对出血性脑卒中患者微创血肿引流术后肺部感染发生具有较高的预测价值。OBJECTIVE To explore serum Toll-like receptor 4(TLR4),triggering receptor expressed on myeloid cell 1(TREM1)in hemorrhagic stroke patients after minimally invasive hematoma drainage and their predictive value for pulmonary infection.METHODS A total of 11o hemorrhagic stroke patients who underwent minimally invasive hematoma drainage in Neurosurgery Department of Lin'an District First People's Hospital were selected between Jan.2021 and Dec.2023,and were divided into 27 cases in the infection group and 83 cases in the non-infection group according to occurrence of pulmonary infection after minimally invasive hematoma drainage.The sputum of patients was collected to isolate and identify pathogens.The levels of serum TLR4,myeloid differentiation factor 88(MyD88)and TREM1 within 24h after surgery were detected by enzyme-linked immunosorbent assay.The relationship among serum TLR4,TREMl and MyD88 in patients with hemorrhagic stroke was analyzed by Pearson correlation analysis.The predictive value of serum TLR4 and TREM1 for pulmonary infection after minimally invasive hematoma drainage in hemorrhagic stroke patients was analyzed by receiver operating characteristic(ROC)curves.RESULTS The incidence of pulmonary infection in hemorrhagic stroke patients after minimally invasive hematoma drainage was 24.55%(27/110),with a total of 34 culture isolates of pathogenic bacteria,predominately Klebsiella pneumoniae(29.41%)and Pseudomonas aeruginosa(17.65%).The levels of serum TLR4,TREM1 and MyD88 in the infection group were(17.32±4.28)μg/L,(352.69±83.45)ng/L and(3.78±0.42)ng/L,higher than those in the non-infection group(P<0.05).Serum TLR4 in hemorrhagic stroke patients was positively correlated with TREM1 and MyD88(r=0.791,0.869,all P<0.001),and TREM1 was also positively correlated with MyD88(r=0.784,P<0.001).The area under curve(AUC)of serum TLR4 and TREMl alone and in combination to predict the occurrence pulmonary infection after minimally invasive hematoma drainage in hemorrhagic stroke patients before surgery were 0.83

关 键 词：出血性脑卒中 微创血肿引流术 肺部感染 TOLL样受体4 髓样细胞触发受体1 预测价值 

分 类 号：R563.1[医药卫生—呼吸系统]