可溶性髓样细胞触发受体-1在呼吸机相关性肺炎的早期诊断及预后评估中的临床应用

发布时间：2019-07-25 08:53

【摘要】：目的探讨可溶性髓样细胞触发受体-1(sTREM-1)在呼吸机相关性肺炎(VAP)患者早期诊断及预后评估的临床应用价值。方法收集2014年1月-2016年10月患者60例,分为VAP组(26例)、非VAP组(34例);另选30名健康志愿者为对照组;在VAP组中根据其28天存活与否分成生存组与死亡组;收集患者机械通气第1、3、5、7天血清和肺泡灌洗液标本,分别检测sTREM-1,血清降钙素原(PCT),血清C-反应蛋白(CRP);采用受试者工作特征(ROC)曲线分析血清CRP、PCT、sTREM-1和灌洗液sTREM-1对VAP的早期诊断价值;应用Logistic回归分析影响VAP患者预后的危险因素。结果 VAP发病率为43.33%,而VAP组28天死亡率高达46.15%;APACHEII评分和28天死亡率,VAP组较非VAP组显著升高(P0.05);气管插管时间、机械通气时间、和ICU住院时间,VAP组较非VAP组的时间显著延长(P0.01);ROC曲线分析CRP、CPT、sTREM-1水平对VAP早期诊断的意义;血清sTREM-1的AUC为0.73;敏感性是0.73,特异性是0.69,(95%CI:0.58~0.88);支气管肺泡灌液sTREM-1的AUC为0.90;敏感性是0.88,特异性是0.82,(95%CI:0.85~0.98)。28天死亡组(12例)的APACHE II评分、血清CRP、血清PCT、血清sTREM-1和灌洗液中sTREM-1均高于生存组(14例),多因素logistic回归分析后,其中支气管肺泡灌洗液中sTREM-1水平及APACHE II评分为预后独立危险因素(P0.05)。结论支气管肺泡灌洗液sTREM-1可作为VAP早期诊断指标,其敏感性及特异性高于血清CRP、PCT、sTREM-1,而且其水平与APACHE II评分均可评估VAP预后。
[Abstract]:Objective to evaluate the clinical value of soluble myeloid cell trigger receptor-1 (sTREM-1) in early diagnosis and prognosis evaluation of ventilator-associated pneumonia (VAP). Methods from January 2014 to October 2016, 60 patients were divided into VAP group (n = 26) and non-VAP group (n = 34). Another 30 healthy volunteers were selected as control group. The patients in VAP group were divided into survival group and death group according to their survival on the 28th day. Serum and alveolar lavage fluid samples were collected on the 1st, 3rd and 7th day of mechanical ventilation, and serum procalcitonin (PCT), serum C-reactive protein (CRP); was detected respectively. The early diagnostic value of serum CRP,PCT,sTREM-1 and lavage fluid sTREM-1 in VAP was analyzed by (ROC) curve of working characteristics of the subjects, and the risk factors affecting the prognosis of VAP patients were analyzed by Logistic regression analysis. Results the incidence of VAP was 43.33%, while the 28-day mortality in VAP group was 46.15% higher than that in non-VAP group (P 0.05), the intubation time, mechanical ventilation time and ICU hospitalization time in VAP group were significantly longer than those in non-VAP group (P 0.01); ROC curve analysis of the significance of CRP,CPT,sTREM-1 level in the early diagnosis of VAP, AUC in serum sTREM-1 was 0.73). The sensitivity was 0.73, the specificity was 0.69, (95%CI:0.58~0.88), the AUC of sTREM-1 was 0.90, and the sensitivity was 0.73, the specificity was 0.69, and the AUC of bronchoalveolar perfusion fluid was 0.90. The sensitivity was 0.88, the specificity was 0.82, (95%CI:0.85~0.98). The APACHE II score of 28 days death group (12 cases), serum CRP, serum PCT, serum sTREM-1 and sTREM-1 in lavage fluid were higher than those in survival group (14 cases). After multivariate logistic regression analysis, sTREM-1 level and APACHE II score in bronchoalveolar lavage fluid were independent prognostic risk factors (P 0.05). Conclusion sTREM-1 in bronchoalveolar lavage fluid can be used as an early diagnostic index of VAP. Its sensitivity and specificity are higher than those of serum CRP,PCT,sTREM-1, and its level and APACHE II score can be used to evaluate the prognosis of VAP.
【作者单位】：北京大学深圳医院ICU;广州医科大学深圳沙井医院ICU;中山大学附属第三医院呼吸内科;
【基金】：深圳市卫计委科研基金资助项目(201506043)
【分类号】：R563.1

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