血清sTREM-1和sCD163对开腹术后患者脓毒症的早期诊断效果

Early diagnosis effect of serum STREM-1 and sCD163 on sepsis after laparotomy

目的探讨血清可溶性髓系细胞触发受体-1(sTREM-1)和可溶性血红蛋白清道夫受体(sCD163)对开腹手术后患者发生脓毒症的早期诊断价值。方法选取2014年1月至2019年12月于永煤集团总医院接受治疗的78例开腹术后脓毒症患者为研究对象,另选取同期接受开腹手术但未发生脓毒症的164例患者为对照组。分别比较术后1 d、7 d健康对照组、局部感染组以及脓毒症组患者血清sTREM-1和sCD163水平;分别比较术后1 d、7 d脓毒症组中不同严重程度的患者血清sTREM-1和sCD163水平。使用ROC曲线分析和logistics多因素回归分析研究sTREM-1和sCD163水平对脓毒症的诊断价值。结果不同感染组比较发现,术后1 d、7 d脓毒症组患者血清sTREM-1和sCD163水平最高,局部感染组次之,且脓毒症水平高于健康对照组和局部感染组(P<0.05)。不同严重程度的脓毒症患者比较发现,脓毒症休克组sTREM-1和sCD163水平最高,严重脓毒症组次之,且脓毒症休克组sTREM-1和sCD163水平高于一般脓毒症组和严重脓毒症组(P<0.05)。ROC曲线分析显示sTREM-1单独诊断灵敏度为78.68%、特异度为90.04%,sCD163水平单独诊断灵敏度为84.23%、特异度为78.56%,二者联合诊断灵敏度为89.12%、特异度为92.31%(P<0.05)。logistics多因素回归分析显示sTREM-1和sCD163水平是开腹手术患者发生脓毒症的危险因素(P<0.05)。结论血清sTREM-1和sCD163可用作开腹手术后患者发生脓毒症的预测指标,sTREM-1和sCD163水平越高表示患者发生脓毒症的可能性越大,临床应加强对患者的预防和控制。

Objective To investigate the early diagnostic value of serum soluble myeloid cell trigger receptor-1(Strem-1)and soluble hemoglobin scavenging receptor(sCD163)in sepsis after laparotomy.Methods Totally 78 patients with sepsis after laparotomy who were treated in our hospital from January 2014 to December 2019 were selected as study subjects,and 164 patients who underwent laparotomy without sepsis during the same period were selected as control subjects.Serum streM-1 and sCD163 levels of healthy control group,local infection group and sepsis group were compared 1 day,7 days after surgery,respectively.Serum streM-1 and sCD163 levels were compared among patients with different severity in the sepsis group 1 and 7 days after surgery,respectively.The diagnostic value of STREM-1 and sCD163 levels in sepsis was studied by USING ROC curve analysis and Logistics multi-factor regression analysis.Results Compared with the different infection signs groups,strem-1 and sCD163 levels were the highest in the sepsis group 1 and 7 days after surgery,followed by the local infection group,and the level of sepsis was much higher than that of the healthy control group and the local infection group(P<0.05).Comparison of patients with different degrees of sepsis showed that strem-1 and sCD163 levels in the septic shock group were the highest,followed by the severe sepsis group,and strem-1 and sCD163 levels in the septic shock group were much higher than those in the general sepsis group and the severe sepsis group(P<0.05).ROC curve analysis showed that strem-1 had a separate diagnostic sensitivity of 78.68%,specificity of 90.04%,sCD163 level of separate diagnostic sensitivity of 84.23%,specificity of 78.56%,combined diagnostic sensitivity of 89.12%,specificity of 92.31%(P<0.05).Logistic multivariate regression analysis showed that strem-1 and sCD163 levels were risk factors for sepsis in patients undergoing open surgery(P<0.05).Conclusion Serum STREM-1 and sCD163 can be used as predictive indexes for sepsis in patients after laparotomy.The higher strem-1 and sCD163 levels are,the more likely the patients are to develop sepsis,so clinical prevention and control should be strengthened.