临床肺科杂志
臨床肺科雜誌
림상폐과잡지
JOUNAL OF CLINICAL PULMONARY MEDICINE
2014年
11期
1956-1959
,共4页
陈偲%杨敬平%银雪%齐眀禄%徐喜媛
陳偲%楊敬平%銀雪%齊眀祿%徐喜媛
진시%양경평%은설%제명록%서희원
脓毒症%TLR-4%TREM-1%sCD14%IL-18%APACHE-Ⅱ评分%ROC
膿毒癥%TLR-4%TREM-1%sCD14%IL-18%APACHE-Ⅱ評分%ROC
농독증%TLR-4%TREM-1%sCD14%IL-18%APACHE-Ⅱ평분%ROC
sepsis%toll-like receptor4%triggering receptors expressed on myeloid cells-1%sCD14%interleu-kin-18%acute physiology and chronic health evaluation-Ⅱ%ROC
目的：探讨脓毒症患者血清TLR-4、TREM-1、sCD14和IL-18含量的变化与脓毒症严重程度的相关性及用于诊断脓毒症的敏感度与特异度。方法选取60例脓毒症患者及30例正常体检者,分别抽血采用酶联免疫法( ELISA法)测TLR-4、TREM-1、sCD14和IL-18的含量。脓毒症患者根据当天进行APACHE-Ⅱ评分结果,按评分≥20分和<20分进入高评分及低评分脓毒症组。结果脓毒症患者上述各因子的含量治疗前均明显高于治疗后,并高于正常对照组(p值均<0.05),并且与APACHE-Ⅱ评分呈正相关(r=0．651、0．662、0．652、0．668,P均<0．05)。治疗前高评分脓毒症组血清中TLR-4、TREM-1、sCD14、IL-18的含量均明显高于低评分脓毒症组( P均<0．05)；脓毒症患者治疗前血清中上述细胞因子的ROC曲线下面积分别为1．000、0．795、0．828、0．834及0．850,APACHE-Ⅱ、TLR4、TREM-1及sCD-14分别取20、25．8 ng/ml、89．6 ng/ml及75 ng/ml为截断点,评价预后敏感性分别为为99%、82%、82%及91%,特异性分别为为100%、52%、66%及72%。结论脓毒症患者血清中TLR-4、TREM-1、sCD14、IL-18的含量与脓毒症的发生发展关系密切；通过监测上述细胞因子的含量可以对脓毒症病情严重程度做出一定的判断；TREM-1有可能成为诊断脓毒症较好的实验室指标之一,sCDl4有望成为较为敏感的脓毒症诊断标志物之一。
目的：探討膿毒癥患者血清TLR-4、TREM-1、sCD14和IL-18含量的變化與膿毒癥嚴重程度的相關性及用于診斷膿毒癥的敏感度與特異度。方法選取60例膿毒癥患者及30例正常體檢者,分彆抽血採用酶聯免疫法( ELISA法)測TLR-4、TREM-1、sCD14和IL-18的含量。膿毒癥患者根據噹天進行APACHE-Ⅱ評分結果,按評分≥20分和<20分進入高評分及低評分膿毒癥組。結果膿毒癥患者上述各因子的含量治療前均明顯高于治療後,併高于正常對照組(p值均<0.05),併且與APACHE-Ⅱ評分呈正相關(r=0．651、0．662、0．652、0．668,P均<0．05)。治療前高評分膿毒癥組血清中TLR-4、TREM-1、sCD14、IL-18的含量均明顯高于低評分膿毒癥組( P均<0．05)；膿毒癥患者治療前血清中上述細胞因子的ROC麯線下麵積分彆為1．000、0．795、0．828、0．834及0．850,APACHE-Ⅱ、TLR4、TREM-1及sCD-14分彆取20、25．8 ng/ml、89．6 ng/ml及75 ng/ml為截斷點,評價預後敏感性分彆為為99%、82%、82%及91%,特異性分彆為為100%、52%、66%及72%。結論膿毒癥患者血清中TLR-4、TREM-1、sCD14、IL-18的含量與膿毒癥的髮生髮展關繫密切；通過鑑測上述細胞因子的含量可以對膿毒癥病情嚴重程度做齣一定的判斷；TREM-1有可能成為診斷膿毒癥較好的實驗室指標之一,sCDl4有望成為較為敏感的膿毒癥診斷標誌物之一。
목적：탐토농독증환자혈청TLR-4、TREM-1、sCD14화IL-18함량적변화여농독증엄중정도적상관성급용우진단농독증적민감도여특이도。방법선취60례농독증환자급30례정상체검자,분별추혈채용매련면역법( ELISA법)측TLR-4、TREM-1、sCD14화IL-18적함량。농독증환자근거당천진행APACHE-Ⅱ평분결과,안평분≥20분화<20분진입고평분급저평분농독증조。결과농독증환자상술각인자적함량치료전균명현고우치료후,병고우정상대조조(p치균<0.05),병차여APACHE-Ⅱ평분정정상관(r=0．651、0．662、0．652、0．668,P균<0．05)。치료전고평분농독증조혈청중TLR-4、TREM-1、sCD14、IL-18적함량균명현고우저평분농독증조( P균<0．05)；농독증환자치료전혈청중상술세포인자적ROC곡선하면적분별위1．000、0．795、0．828、0．834급0．850,APACHE-Ⅱ、TLR4、TREM-1급sCD-14분별취20、25．8 ng/ml、89．6 ng/ml급75 ng/ml위절단점,평개예후민감성분별위위99%、82%、82%급91%,특이성분별위위100%、52%、66%급72%。결론농독증환자혈청중TLR-4、TREM-1、sCD14、IL-18적함량여농독증적발생발전관계밀절；통과감측상술세포인자적함량가이대농독증병정엄중정도주출일정적판단；TREM-1유가능성위진단농독증교호적실험실지표지일,sCDl4유망성위교위민감적농독증진단표지물지일。
Objective To investigate the changes of TLR-4, TREM-1, sCD14 and IL-18 in serum of pa-tients with sepsis and their relationships to the diagnostic sensitivity and specificity of sepsis. Methods The study selected 60 patients with sepsis and 30 healthy people as the normal control group. The levels of TLR-4, TREM-1, sCD14 and IL-18 in venous blood were detected by enzyme-linked immunosorbent assay ( ELISA) . Results There were significant differences in the contents of TLR-4, TREM-1, sCD14 and IL-18 of patients with sepsis before and after the treatment, and they were obviously higher in the observation group than in the normal control group ( P<0. 05). The contents of TLR-4, TREM-1, sCD14 and IL-18 were all positively correlated with APACHE-Ⅱscore in patients with sepsis (r=0. 651, 0. 662, 0. 652 and 0. 668, (P<0. 05). The serum contents of TLR-4, TREM-1, sCD14 and IL-18 were significantly higher in high score of APACHE-Ⅱ group than in the low score group ( P <0. 05). The area under ROC curve of the contents of TLR-4, TREM-1, sCD14 and IL-18 of sepsis patients before treatment were 1. 000, 0. 795, 0. 828, 0. 834 and 0. 850 respectively. Taking APACHE-Ⅱ and sCD-14, TLR4, TREM-1 of 20, 25. 8 ng/ml, 89. 6 ng/ml and 75 ng/ml as cut-off points, the sensitivity was 99%, 82%, 82% and 99% respectively, and the specificity was 100%, 52%, 66% and 100% respectively. Conclusion The contents of serum TLR-4, sCD14, IL-18 and TREM-1 in patients of sepsis are closely associated with the occurrence of sepsis development. We can make a judgment of severity of sepsis by monitoring the levels of cytokines above. TREM-1 may be one of the better indexes of diagnosis of sepsis. SCDl4 is expected to become one of the sensitive diagnostic mark-ers of sepsis.
