CAJ | 학술논문

目的：探讨血清及呼出气冷凝液（EVC）中可溶性髓系细胞触发受体-1（sTREM-1）对呼吸机相关性肺炎（VAP）早期诊断及预后判断的临床价值。方法对37例机械通气患者进行治疗后评估，分成非感染组13例，感染组24例（其中治疗有效组14例，治疗无效组10例），所有患者均在机械通气后第1、3、5、7天应用双抗体夹心酶联免疫吸附法（DAS-ELISA）测定血清和 EVC 中 sTREM-1水平，并记录下呼吸道分泌物细菌培养结果和患者治疗后转归；应用受试者工作特征曲线（ROC）研究 sTREM-1对 VAP 早期诊断效能及预后判断价值。结果第1天，血清及 EVC 中 sTREM-1水平治疗有效组、治疗无效组及非感染组比较，差异无统计学意义（P ＞0．05）；第3天和第5天，感染组较非感染组有明显升高（P ＜0．01）；第7天，治疗无效组仍处较高水平，与治疗有效组、非感染组比较差异有统计学意义（P ＜0．01），而治疗有效组与非感染组比较差异无统计学意义（P ＞0．05）。应用 ROC 分析，第3天血清和 EVC 中 sTREM-1曲线下面积分别为0．897、0．909。以第3天 EVC 中sTREM-14．70 ng/mL 为 VAP 的早期诊断界值，其诊断灵敏度为95．8％，特异度为92．3％。结论血清和 EVC 中sTREM-1检测有助于 VAP 的早期诊断，第7天血清和 EVC 中 sTREM-1水平有助于判断 VAP 的预后（撤机失败和死亡），与血清标本比较，EVC 的获得更加方便。
목적：탐토혈청급호출기냉응액（EVC）중가용성수계세포촉발수체-1（sTREM-1）대호흡궤상관성폐염（VAP）조기진단급예후판단적림상개치。방법대37례궤계통기환자진행치료후평고，분성비감염조13례，감염조24례（기중치료유효조14례，치료무효조10례），소유환자균재궤계통기후제1、3、5、7천응용쌍항체협심매련면역흡부법（DAS-ELISA）측정혈청화 EVC 중 sTREM-1수평，병기록하호흡도분비물세균배양결과화환자치료후전귀；응용수시자공작특정곡선（ROC）연구 sTREM-1대 VAP 조기진단효능급예후판단개치。결과제1천，혈청급 EVC 중 sTREM-1수평치료유효조、치료무효조급비감염조비교，차이무통계학의의（P ＞0．05）；제3천화제5천，감염조교비감염조유명현승고（P ＜0．01）；제7천，치료무효조잉처교고수평，여치료유효조、비감염조비교차이유통계학의의（P ＜0．01），이치료유효조여비감염조비교차이무통계학의의（P ＞0．05）。응용 ROC 분석，제3천혈청화 EVC 중 sTREM-1곡선하면적분별위0．897、0．909。이제3천 EVC 중sTREM-14．70 ng/mL 위 VAP 적조기진단계치，기진단령민도위95．8％，특이도위92．3％。결론혈청화 EVC 중sTREM-1검측유조우 VAP 적조기진단，제7천혈청화 EVC 중 sTREM-1수평유조우판단 VAP 적예후（철궤실패화사망），여혈청표본비교，EVC 적획득경가방편。
Objective This study examined the value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)in serum and exhaled ventilator condensate (EVC)in early diagnosis and prognosis of ventilator-associated pneumonia (VAP). Methods A total of 37 adult patients undergoing mechanical ventilation were evaluated after treatment,including 24 patients with infection,13 without infection.Of the 24 patients with infection,10 patients were assigned to ineffective subgroup and 14 to effective subgroup.Levels of sTREM-1 in serum and EVC were measured on days 1,3,5,and 7 for all patients.sTREM-1 in serum and EVC were determined in patients by double antibody sandwich enzyme-linked immunosorbant assay (DAS-ELISA).The early diagnostic and prognostic value was assessed by receiver operating characteristic (ROC)curve analysis.Re-sults On Day 1,the sTREM-1 levels in serum and EVC did not show significant difference between the three groups (P>0.05).On Day 3 and Day 5,the level of sTREM-1 in the infection group was higher than that in the non-infection group (P <0.01).On Day 7,the sTREM-1 levels of serum and EVC in ineffective subgroup were higher than those in the effective subgroup and non-infection group (P <0.01). There were no difference between the non-infection group and effective subgroup (P >0.05).For ROC analysis,area under the curve (AUC)of serum sTREM-1 was 0.897,and AUC of EVC sTREM-1 was 0.909 on Day 3.When the cut-off value of EVC sTREM-1 was set at 4.70 ng/mL on Day 3,the sensitivity was 85.8%,specificity was 92.3%.Conclusions The results suggest that the levels of sTREM-1 in serum and EVC are conducive to the early diagnosis of VAP.The levels of sTREM-1 in serum and EVC on Day 7 are helpful for estimating the prognosis.EVC sample is easier to collect than serum.