sTREM-1、PCT及ET与重症肺炎患者预后的关系  

The relationship of sTREM-1,PCT and ET with prognosis of patients with severe pneumonia

作　　者：傅顺金 廖岐鸣 金剑敏 汪群智[1] FU Shunjin;LIAO Qiming;JIN Jianmin;WANG Qunzhi(Emergency Medicine Center,Jinhua People’s Hospital,Affiliated Jinhua Hospital of Wenzhou Medical University,Jinhua 321000,Zhejiang,China;Hemodialysis Room,Jinhua People’s Hospital,Affiliated Jinhua Hospital of Wenzhou Medical University,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市人民医院温州医科大学附属金华医院急诊医学中心,浙江金华321000 [2]金华市人民医院温州医科大学附属金华医院血透室,浙江金华321000

出　　处：《中国现代医生》2025年第12期53-56,131,共5页China Modern Doctor

摘　　要：目的探讨血清可溶性髓样细胞触发受体–1(soluble triggering receptor expressed on myeloid cells–1,sTREM–1)、降钙素原(procalcitonin,PCT)及内毒素(endotoxin,ET)水平与重症肺炎患者预后的关系。方法选取2022年1月至2023年1月于金华市人民医院就诊的200例重症肺炎患者作为研究组,普通肺炎患者100例作为对照组。研究组患者根据28d预后情况进一步分为死亡组和存活组。检测患者血清中sTREM–1、PCT和ET水平,比较各组间的差异;分析重症肺炎患者入院第1天血清指标与急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的关系;采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析入院第1天血清sTREM–1、PCT联合ET水平对重症肺炎患者预后的诊断效能。结果研究组患者入院第1天血清sTREM–1、PCT和ET水平均显著高于对照组(P<0.05)。重症肺炎死亡组患者入院第4天和第7天的血清sTREM–1、PCT、ET水平及APACHEⅡ评分较入院第1天均显著上升(P<0.05),存活组上述指标在入院第4天和第7天较入院第1天均显著下降(P<0.05)。重症肺炎死亡组患者入院第1天、第4天和第7天的血清sTREM–1、PCT、ET水平及APACHEⅡ评分均显著高于同时间点存活组(P<0.05)。重症肺炎患者入院第1天血清sTREM–1、PCT和ET水平均与APACHEⅡ评分呈正相关(P<0.05),且各血清指标间亦呈正相关(P<0.05)。ROC分析显示,入院第1天血清sTREM–1>56.90ng/L时,诊断重症肺炎患者死亡的敏感度为89.13%,特异性为75.32%;PCT>12.97μg/L时,敏感度为76.09%,特异性为85.06%;ET>13.62pg/ml时,敏感度为73.91%,特异性为66.88%。三项指标联合检测的敏感度和特异性分别为89.13%和96.75%。结论血清sTREM–1、PCT和ET水平在重症肺炎患者中均显著升高,且与患者预后密切相关。三者联合检测对重症肺炎患者死亡风险的预测价值较高。Objective To explore the relationship between serum levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT)combined with endotoxin(ET)and prognosis of patients with severe pneumonia.Methods 200 cases of severe pneumonia and 100 cases of common pneumonia admitted to Jinhua People’s Hospital from January 2022 to January 2023 were selected as study group and control group respectively.Patients in study group were divided into death group and survival group according to the prognosis of 28 days.Serum sTREM-1,PCT and ET levels were detected in all patients,and the differences among all groups were compared;The relationship between serum indexes and acute physiology and chronic health evaluationⅡ(APACHEⅡ)on the first day of admission was analyzed;Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of serum sTREM-1,PCT and ET levels on the first day after admission to the hospital.Results Serum sTREM-1,PCT and ET levels in study group were significantly higher than those in control group on the 1st day after admission(P<0.05).Serum sTREM-1,PCT,ET levels and APACHEⅡscore in death group were significantly increased on the 4th and 7th day after admission compared with the 1st day(P<0.05),while the above indexes in survival group were significantly decreased on the 4th and 7th day after admission compared with the 1st day(P<0.05).Serum sTREM-1,PCT,ET levels and APACHEⅡscores in severe pneumonia death group were significantly higher than those in survival group on the 1st day,4th day and 7th day after admission(P<0.05).Serum sTREM-1,PCT,ET levels were positively correlated with APACHEⅡscore(P<0.05),and serum indexes were positively correlated in severe pneumonia patients on the 1st day after admission(P<0.05).When serum sTREM-1>56.90ng/L on the 1st day after admission,the sensitivity and specificity of patients with severe pneumonia was 89.13%and 75.32%respectively;When PCT>12.97μg/L,the sensitivity and specificity was 76.09%and 85.06%;Wh

关 键 词：重症肺炎 可溶性髓样细胞触发受体–1 降钙素原 内毒素 预后 

分 类 号：R563.1[医药卫生—呼吸系统]