中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2014年
11期
970-976
,共7页
可溶性髓细胞触发受体-1( sTREM-1)%脓毒症%诊断%预后
可溶性髓細胞觸髮受體-1( sTREM-1)%膿毒癥%診斷%預後
가용성수세포촉발수체-1( sTREM-1)%농독증%진단%예후
Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)%Sepsis%Diagnosis%Prognosis
目的检测新入ICU患者血清和肺泡灌洗液可溶性髓细胞触发受体-1（sTREM-1），探讨sTREM-1在伴肺部渗出的脓毒症（ sepsis ）患者中的变化及意义。方法选择我院ICU 2012-09～2013-09收治的伴有肺部渗出及全身炎症反应综合征（ SIRS）的机械通气患者70例作为试验组，根据其临床特点及病原学检测结果，分为脓毒症组39例，非感染性SIRS组31例。两组在入院的第1、4、7天和第1、4天分别收集血清和肺泡灌洗液（ BALF）标本，同期纳入血清对照组30例，BALF对照组35例。采用酶联免疫吸附试验（ELISA）测定sTREM-1质量浓度，比较不同部位sTREM-1质量浓度与同期检测各种生物标志物对脓毒症的诊断及预后判断参数。结果①入院第1天脓毒症组血清sTREM-1质量浓度[425.20（653．72）pg/mL]，与血清对照组（84.33±24．03）pg/mL及SIRS组[99．74（67．54）pg/mL]比较差异均有统计学意义（P＜0．01）；②入院第1天区分脓毒症与SIRS诊断的各参数ROC曲线下面积（ AUC）依次为血清sTREM-1（0．796）、CRP（0．668），而入院第4天两组比较仅血清 sTREM -1差异有统计学意义（P ＝0.001），其AUC为0．837；③各时间点脓毒症死亡组血清sTREM-1质量浓度均显著高于生存组（P＜0．05），其中入院第1天判断脓毒症组预后各参数AUC依次为血清sTREM-1（0．792）、SOFA评分（0．756）；入院第4天依次为 SOFA 评分（0．801）、APACHEⅡ评分（0．757）、血清sTREM-1（0．696）；入院第7天依次为APACHEⅡ评分（0．835）、血清sTREM-1（0．725）；④入院第1、4及7天脓毒症生存组肺泡灌洗液sTREM-1质量浓度分别为（99．22±129．94，204．67±147．42，169．51±157．04）pg/mL，差异有统计学意义（P＝0．001），而脓毒症死亡组不同时间点间比较差异无统计学意义（P＞0．05）。结论血清sTREM-1在伴有肺部渗出的脓毒症患者中呈高表达，显著高于SIRS患者及健康人群，其在脓毒症早期具有优于其他标志物的诊断与判断预后的能力，且肺泡灌洗液sTREM-1在病程后期下降，提示预后良好。
目的檢測新入ICU患者血清和肺泡灌洗液可溶性髓細胞觸髮受體-1（sTREM-1），探討sTREM-1在伴肺部滲齣的膿毒癥（ sepsis ）患者中的變化及意義。方法選擇我院ICU 2012-09～2013-09收治的伴有肺部滲齣及全身炎癥反應綜閤徵（ SIRS）的機械通氣患者70例作為試驗組，根據其臨床特點及病原學檢測結果，分為膿毒癥組39例，非感染性SIRS組31例。兩組在入院的第1、4、7天和第1、4天分彆收集血清和肺泡灌洗液（ BALF）標本，同期納入血清對照組30例，BALF對照組35例。採用酶聯免疫吸附試驗（ELISA）測定sTREM-1質量濃度，比較不同部位sTREM-1質量濃度與同期檢測各種生物標誌物對膿毒癥的診斷及預後判斷參數。結果①入院第1天膿毒癥組血清sTREM-1質量濃度[425.20（653．72）pg/mL]，與血清對照組（84.33±24．03）pg/mL及SIRS組[99．74（67．54）pg/mL]比較差異均有統計學意義（P＜0．01）；②入院第1天區分膿毒癥與SIRS診斷的各參數ROC麯線下麵積（ AUC）依次為血清sTREM-1（0．796）、CRP（0．668），而入院第4天兩組比較僅血清 sTREM -1差異有統計學意義（P ＝0.001），其AUC為0．837；③各時間點膿毒癥死亡組血清sTREM-1質量濃度均顯著高于生存組（P＜0．05），其中入院第1天判斷膿毒癥組預後各參數AUC依次為血清sTREM-1（0．792）、SOFA評分（0．756）；入院第4天依次為 SOFA 評分（0．801）、APACHEⅡ評分（0．757）、血清sTREM-1（0．696）；入院第7天依次為APACHEⅡ評分（0．835）、血清sTREM-1（0．725）；④入院第1、4及7天膿毒癥生存組肺泡灌洗液sTREM-1質量濃度分彆為（99．22±129．94，204．67±147．42，169．51±157．04）pg/mL，差異有統計學意義（P＝0．001），而膿毒癥死亡組不同時間點間比較差異無統計學意義（P＞0．05）。結論血清sTREM-1在伴有肺部滲齣的膿毒癥患者中呈高錶達，顯著高于SIRS患者及健康人群，其在膿毒癥早期具有優于其他標誌物的診斷與判斷預後的能力，且肺泡灌洗液sTREM-1在病程後期下降，提示預後良好。
목적검측신입ICU환자혈청화폐포관세액가용성수세포촉발수체-1（sTREM-1），탐토sTREM-1재반폐부삼출적농독증（ sepsis ）환자중적변화급의의。방법선택아원ICU 2012-09～2013-09수치적반유폐부삼출급전신염증반응종합정（ SIRS）적궤계통기환자70례작위시험조，근거기림상특점급병원학검측결과，분위농독증조39례，비감염성SIRS조31례。량조재입원적제1、4、7천화제1、4천분별수집혈청화폐포관세액（ BALF）표본，동기납입혈청대조조30례，BALF대조조35례。채용매련면역흡부시험（ELISA）측정sTREM-1질량농도，비교불동부위sTREM-1질량농도여동기검측각충생물표지물대농독증적진단급예후판단삼수。결과①입원제1천농독증조혈청sTREM-1질량농도[425.20（653．72）pg/mL]，여혈청대조조（84.33±24．03）pg/mL급SIRS조[99．74（67．54）pg/mL]비교차이균유통계학의의（P＜0．01）；②입원제1천구분농독증여SIRS진단적각삼수ROC곡선하면적（ AUC）의차위혈청sTREM-1（0．796）、CRP（0．668），이입원제4천량조비교부혈청 sTREM -1차이유통계학의의（P ＝0.001），기AUC위0．837；③각시간점농독증사망조혈청sTREM-1질량농도균현저고우생존조（P＜0．05），기중입원제1천판단농독증조예후각삼수AUC의차위혈청sTREM-1（0．792）、SOFA평분（0．756）；입원제4천의차위 SOFA 평분（0．801）、APACHEⅡ평분（0．757）、혈청sTREM-1（0．696）；입원제7천의차위APACHEⅡ평분（0．835）、혈청sTREM-1（0．725）；④입원제1、4급7천농독증생존조폐포관세액sTREM-1질량농도분별위（99．22±129．94，204．67±147．42，169．51±157．04）pg/mL，차이유통계학의의（P＝0．001），이농독증사망조불동시간점간비교차이무통계학의의（P＞0．05）。결론혈청sTREM-1재반유폐부삼출적농독증환자중정고표체，현저고우SIRS환자급건강인군，기재농독증조기구유우우기타표지물적진단여판단예후적능력，차폐포관세액sTREM-1재병정후기하강，제시예후량호。
Objective To detect the serum and Broncho alveolar lavage fluid (BALF) levels of soluble triggering receptor expressed on myeloid cells -1 ( sTREM -1 ) so as to investigate the significance of sTREM-1 in sepsis patients with pulmonary infiltrates.Methods Seventy ICU patients with pulmonary infiltrates and systemic inflammatory response syndrome ( SIRS ) were enrolled in test group from September 2012 to September 2013.According to the clinical features and results of the pathogens, the patients were divided into two subgroups:39 with sepsis, 31with SIRS.BALF and blood samples were collected on day 1, 4, 7 in sepsis group and day 1, 4 in SIRS group.Thirty normal subjects and 35 patients without SIRS from Department of Respiratory Medicine served as serum and BALF controls.Levels of sTREM-1 was measured by enzyme-linked immunosorbent assay ( ELISA) . The early diagnostic and prognostic value was assessed by receiver operating characteristic ( ROC) curve analysis.Results ①The levels of BALF sTREM-1 in sepsis group on day 1 [425.20 (653.72) pg/mL] were significantly higher than those in serum controls (84.33 ±24.03 pgm/L) and in SIRS group [99.74 (67.54) pg/mL] (P<0.01).②The area under the curve (AUC) in ROC of ssTREM-1 and CRP for the diagnosis of sepsis were 0.796 and 0.668 on day 1, while only ssTREM-1 with 0.837 on day 4.③ ssTREM-1 levels were significantly higher in the non-survivor than in the survivor group at each time point;the AUC in ROC of ssTREM-1 and SOFA for the prognosis of sepsis survive were 0.792 and 0.756 on day 1;SOFA, APACHEⅡand ssTREM-1 were 0.801, 0.757 and 0.696 on day 4, while APACHEⅡand ssTREM -1 were 0.835 and 0.725 on day 7.④There was a significant difference between the levels of BALF sTREM -1 in survivors in sepsis group on day 1, 4 and 7 (99.22 ±129.94, 204.67 ±147.42, 169.51 ±157.04) pg/mL (P=0.001), while no significant difference between non-survivors.Con clusion The sTREM-1 has high expression level in serum in sepsis patients with pulmonary infiltrates.This suggests it may be a mild index for sepsis diagnosis and prognosis judgment, better than other clinical biomarkers in early stage.The decline of sTREM-1 in BALF is associated with favorable prognosis.
