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54例机械通气患者进行治疗后评估,分成2组:非VAP组18例,VAP组36例(其中治疗有效组20例,治疗无效组16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测定血清和EVC中sTREM-1、降钙素原(PCT)水平,应用受试者工作特征(ROC)曲线研究sTREM-1、PCT等指标对VAP早期诊断效能及预后判断价值.结果第3天和第5天,VAP组血清及EVC中sTREM-1较非VAP组有明显升高(P＜0.01);第7天,血清及EVC中sTREM-1在治疗无效组仍处较高水平,与治疗有效组、非VAP组比较差异有统计学意义(P＜0.01).在VAP组,血清PCT水平在第5天有明显升高(P＜0.05);第7天,与治疗有效组和非VAP组比较,治疗无效组血清PCT水平仍持续升高(P＜0.01);而EVC中PCT浓度仅在第7天治疗无效组患者中处于较高水平,与非VAP组、治疗有效组比较,差异有统计学意义(P＜0.01).应用ROC分析,以第3天EVC中sTREM-1 4.02 μg/L为VAP的早期诊断界值,其敏感度为86.1％,特异度为66.7％,阳性预测值为83.8％,阴性预测值为70.6％(95％ CI:0.631～0.979).结论第3天血清和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、PCT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.방법 대54례궤계통기환자진행치료후평고,분성2조:비VAP조18례,VAP조36례(기중치료유효조20례,치료무효조16례),소유환자균재궤계통기후제1、3、5、7천응용쌍항체협심매련면역흡부법측정혈청화EVC중sTREM-1、강개소원(PCT)수평,응용수시자공작특정(ROC)곡선연구sTREM-1、PCT등지표대VAP조기진단효능급예후판단개치.결과 제3천화제5천,VAP조혈청급EVC중sTREM-1교비VAP조유명현승고(P＜0.01);제7천,혈청급EVC중sTREM-1재치료무효조잉처교고수평,여치료유효조、비VAP조비교차이유통계학의의(P＜0.01).재VAP조,혈청PCT수평재제5천유명현승고(P＜0.05);제7천,여치료유효조화비VAP조비교,치료무효조혈청PCT수평잉지속승고(P＜0.01);이EVC중PCT농도부재제7천치료무효조환자중처우교고수평,여비VAP조、치료유효조비교,차이유통계학의의(P＜0.01).응용ROC분석,이제3천EVC중sTREM-1 4.02 μg/L위VAP적조기진단계치,기민감도위86.1％,특이도위66.7％,양성예측치위83.8％,음성예측치위70.6％(95％ CI:0.631～0.979).결론 제3천혈청화EVC중sTREM-1검측유조우VAP적조기진단,제7천혈청화EVC중sTREM-1、PCT수평유조우판단VAP적예후(철궤실패화사망).여혈청표본비교,EVC적획득경가방편.
Objective To discuss the value of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in serum and exhaled ventilator condensate (EVC) to diagnose ventilator-associated pneumonia(VAP)and predict the prognosis.Methods 54 adult patients with mechanical ventilation were valuated after treatment.54 cases were divided into two groups:36 patients in infection group,18 cases in non-infection group.The 36 patients with infection included 16 cases in ineffective subgroup and 20 cases in effective subgroup.Levels of sTREM-1 and procalcitionin (PCT) in serum and EVC were determined by double antibody sandwich enzyme-linked immunosorbant assay on the 1st,3rd,5th,and 7th day after ventilation.The early diagnostic value and prognostic estimate were assessed by receiver operating characteristic (ROC) curve analysis.Results On the 3rd day and 5th day,the level of sTREM-1 in the serum and EVC of infection group was higher than that of non-infection group (P ＜0.01).On the 7th day,level of sTREM-1 in the serum and EVC of ineffective subgroup was higher than that of effective subgroup and non-infection group (P ＜0.01).In the VAP group,serum PCT level increased significantly on the 5th day (P ＜0.05).On the 7th day,compared with non-infection group and effective subgroup,serum PCT level continued to increase in ineffective group (P ＜ 0.01),the concentration of PCT in EVC was higher in ineffective group (P ＜ 0.01).For ROC curve,when the cut-off value of sTREM-1 in EVC was set at 4.02 μg/L on the 3 rd day,the sensitivity was 86.1％,specificity was 66.7 ％,positive predictive value was 83.8％,negative predictive value was 70.6％ (95％ CI:0.631-0.979).Conclusions The level of sTREM-1 in serum and EVC is conducive to the early diagnosis of VAP,and the level on the 7th day is helpful to estimate the prognosis.Compared with serum,the sample of EVC is easier to collect.