外周血PCT、IL-17、sTREM-1检测在呼吸机相关性肺炎诊断中的价值
发布时间：2018-11-27 18:39
【摘要】：目的:观测机械通气并发生呼吸机相关性肺炎(VAP)患者外周血中PCT、IL-17和s TREM-1浓度变化并探讨PCT、IL-17、s TREM-1对VAP的诊断价值。方法:在蚌埠医学院第一附属医院ICU 2015年4月-2016年4月期间,采集欲行呼吸机治疗患者的外周静脉血,此标本纳入MV0h组;行呼吸机治疗满48小时,但明确诊断未并发VAP的患者,48小时时采集其外周静脉血,此标本纳入MV-NVAP组;行机械通气满48小时后,明确诊断并发VAP的患者,立即采集其外周静脉血,此标本纳入VAP组。每个患者观察时间窗定为7天,7天内未发生VAP的患者予以剔除。血清样本均采用ELISA测定PCT、IL-17和s TREM-1浓度,数据采用SPSS18.0软件进行统计学分析。结果:MV-NVAP组血清样本中PCT、IL-17和s TREM-1水平均高于MV0h,P0.05,无统计学意义。VAP组血清样本中PCT、IL-17和s TREM-1水平均高于MV0h、MV-NVAP组,P0.05,具有统计学意义。PCT的受试者工作曲线(ROC曲线)下面积为0.856,当血清中PCT水平达到104.7864pg/ml时,诊断VAP的灵敏度为73.9%,特异度为84.8%。IL-17的ROC曲线下面积为0.887,当血清中IL-17水平达到136.9726pg/ml时,诊断VAP的灵敏度为70.8%,特异度为91.7%。s TREM-1的ROC曲线下面积为0.813,当血清中s TREM-1水平达到95.4204pg/ml时,诊断VAP的灵敏度为72.4%,特异度为79.3%;联合PCT、IL-17两种指标诊断VAP的ROC曲线下面积为0.816,诊断灵敏度为78.7%,特异度为71.0%。联合PCT、s TREM-1两种指标诊断VAP的ROC曲线下面积为0.791,诊断灵敏度为82.0%,特异度为54.8%。联合IL-17、s TREM-1两种指标诊断VAP的ROC曲线下面积为0.812,诊断灵敏度为78.7%,特异度为71.0%。联合PCT、IL-17、s TREM-1三种指标诊断VAP的ROC曲线下面积为0.973,诊断灵敏度为84.4%,特异度为90.6%。结论:行呼吸机支持治疗48小时后,机械通气所致的机械性损伤可能导致患者体内PCT、IL-17、s TREM-1水平升高。联合PCT、IL-17对VAP的诊断灵敏度较单一指标提高,但特异度略低。联合PCT、s TREM-1对VAP的诊断灵敏度较单一指标明显提高,但特异度较低。联合IL-17、s TREM-1对VAP的诊断灵敏度较单一指标提高,但特异度略低。联合PCT、IL-17、s TREM-1对VAP进行诊断,其诊断灵敏度较单一指标、两两联合指标明显提高,特异度较PCT、s TREM-1、两两联合指标明显提高,但较IL-17略低。患者外周血中PCT、IL-17、s TREM-1水平对VAP均具有一定的辅助诊断价值。
[Abstract]:Objective: to observe the changes of PCT,IL-17 and s TREM-1 in peripheral blood of patients with mechanical ventilation and ventilator-associated pneumonia (VAP) and to explore the diagnostic value of PCT,IL-17,s TREM-1 in VAP. Methods: from April 2015 to April 2016, peripheral venous blood samples were collected from patients in the first affiliated Hospital of Bengbu Medical College from April 2015 to April 2016. The blood samples were included in the MV0h group. The peripheral venous blood was collected at 48 hours after ventilator treatment, but not complicated with VAP. The samples were included in MV-NVAP group. After 48 hours of mechanical ventilation, the patients with VAP were diagnosed and their peripheral venous blood was collected immediately. The samples were included in the VAP group. Each patient's observation window was set at 7 days and those without VAP within 7 days were excluded. The concentrations of PCT,IL-17 and s TREM-1 were measured by ELISA, and the data were analyzed by SPSS18.0 software. Results: the levels of PCT,IL-17 and s TREM-1 in serum samples of MV-NVAP group were higher than those in MV0h,P0.05, group, but the levels of PCT,IL-17 and s TREM-1 in VAP group were higher than those in MV0h,MV-NVAP group (P 0.05). The area under the operating curve (ROC curve) of PCT subjects was 0.856. When the serum PCT level reached 104.7864pg/ml, the sensitivity of diagnosing VAP was 73.9%. The area under the ROC curve with specificity of 84.8%.IL-17 was 0.887.When the level of IL-17 in serum reached 136.9726pg/ml, the sensitivity of diagnosis of VAP was 70.8. The area under the ROC curve with specificity of 91.7? s TREM-1 was 0.813. When the level of s TREM-1 in serum reached 95.4204pg/ml, the sensitivity and specificity of diagnosis of VAP were 72.4 and 79.3 respectively. The area under the ROC curve of VAP combined with PCT,IL-17 was 0.816, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,s TREM-1 was 0.791.The diagnostic sensitivity was 82.0 and the specificity was 54.8. The area under the ROC curve of VAP combined with IL-17,s TREM-1 was 0.812, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,IL-17,s TREM-1 was 0.973, the diagnostic sensitivity was 84.4 and the specificity was 90.6. Conclusion: mechanical injury induced by mechanical ventilation may lead to the increase of PCT,IL-17,s TREM-1 level in patients 48 hours after ventilator support therapy. The diagnostic sensitivity of combined PCT,IL-17 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity of combined PCT,s TREM-1 for VAP was significantly higher than that of single index, but the specificity was lower. The diagnostic sensitivity of combined IL-17,s TREM-1 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity and specificity of combined PCT,IL-17,s TREM-1 in diagnosis of VAP were significantly higher than that of single index, pairwise combination index and PCT,s TREM-1, combination index, but slightly lower than that of IL-17. The level of PCT,IL-17,s TREM-1 in peripheral blood of patients has some auxiliary diagnostic value for VAP.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1
本文编号：2361699
[Abstract]:Objective: to observe the changes of PCT,IL-17 and s TREM-1 in peripheral blood of patients with mechanical ventilation and ventilator-associated pneumonia (VAP) and to explore the diagnostic value of PCT,IL-17,s TREM-1 in VAP. Methods: from April 2015 to April 2016, peripheral venous blood samples were collected from patients in the first affiliated Hospital of Bengbu Medical College from April 2015 to April 2016. The blood samples were included in the MV0h group. The peripheral venous blood was collected at 48 hours after ventilator treatment, but not complicated with VAP. The samples were included in MV-NVAP group. After 48 hours of mechanical ventilation, the patients with VAP were diagnosed and their peripheral venous blood was collected immediately. The samples were included in the VAP group. Each patient's observation window was set at 7 days and those without VAP within 7 days were excluded. The concentrations of PCT,IL-17 and s TREM-1 were measured by ELISA, and the data were analyzed by SPSS18.0 software. Results: the levels of PCT,IL-17 and s TREM-1 in serum samples of MV-NVAP group were higher than those in MV0h,P0.05, group, but the levels of PCT,IL-17 and s TREM-1 in VAP group were higher than those in MV0h,MV-NVAP group (P 0.05). The area under the operating curve (ROC curve) of PCT subjects was 0.856. When the serum PCT level reached 104.7864pg/ml, the sensitivity of diagnosing VAP was 73.9%. The area under the ROC curve with specificity of 84.8%.IL-17 was 0.887.When the level of IL-17 in serum reached 136.9726pg/ml, the sensitivity of diagnosis of VAP was 70.8. The area under the ROC curve with specificity of 91.7? s TREM-1 was 0.813. When the level of s TREM-1 in serum reached 95.4204pg/ml, the sensitivity and specificity of diagnosis of VAP were 72.4 and 79.3 respectively. The area under the ROC curve of VAP combined with PCT,IL-17 was 0.816, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,s TREM-1 was 0.791.The diagnostic sensitivity was 82.0 and the specificity was 54.8. The area under the ROC curve of VAP combined with IL-17,s TREM-1 was 0.812, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,IL-17,s TREM-1 was 0.973, the diagnostic sensitivity was 84.4 and the specificity was 90.6. Conclusion: mechanical injury induced by mechanical ventilation may lead to the increase of PCT,IL-17,s TREM-1 level in patients 48 hours after ventilator support therapy. The diagnostic sensitivity of combined PCT,IL-17 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity of combined PCT,s TREM-1 for VAP was significantly higher than that of single index, but the specificity was lower. The diagnostic sensitivity of combined IL-17,s TREM-1 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity and specificity of combined PCT,IL-17,s TREM-1 in diagnosis of VAP were significantly higher than that of single index, pairwise combination index and PCT,s TREM-1, combination index, but slightly lower than that of IL-17. The level of PCT,IL-17,s TREM-1 in peripheral blood of patients has some auxiliary diagnostic value for VAP.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1
【参考文献】
相关期刊论文 前10条
1 杨康康;董琳;丁洁;;Th17及IL-17在呼吸道合胞病毒感染气道黏液高分泌的作用研究进展[J];国际呼吸杂志;2016年14期
2 仲美凤;赵建美;;血浆CD64和可溶性髓系细胞触发受体-1在肺炎患儿中的诊断价值[J];中国当代儿科杂志;2016年07期
3 黄妍华;;多重耐药菌所致呼吸机相关性肺炎的临床疗效分析[J];临床肺科杂志;2016年04期
4 陈振华;丘新才;林淑芳;;降钙素原在慢性阻塞性肺疾病急性加重期抗感染治疗的应用价值[J];国际呼吸杂志;2016年05期
5 许灿龙;;肺炎患儿血清IL-8、IL-17、磷脂酶A2的表达及临床意义[J];中国农村卫生事业管理;2015年10期
6 张晓勤;黎嘉嘉;刘池;程德云;;降钙素原、髓系细胞表达的触发受体-1联合临床肺部感染评分对呼吸机相关性肺炎的早期诊断价值[J];东南大学学报(医学版);2015年04期
7 冒秀宏;孙卫和;崔广清;李旭忠;;抗生素降阶梯治疗重症监护病房呼吸机相关性肺炎的临床探讨[J];中外医疗;2015年20期
8 翁帮琼;孙启蓉;王昌明;;早期不同营养方式对老年呼吸机相关性肺炎的疗效分析[J];临床肺科杂志;2015年07期
9 曾明旋;胡斌;程知音;辛恺;洪玉婷;;降钙素原与C-反应蛋白对呼吸机相关性肺炎患者的诊断研究[J];中华医院感染学杂志;2015年08期
10 黄燕新;姜朝新;叶振望;曾庆洋;;血清降钙素原检测对血流感染的诊断价值分析[J];检验医学与临床;2014年17期
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