髓样细胞触发受体-1用于监测肝移植患者术后感染的价值

Value of triggering receptor expressed on myeloid cells-1 in monitoring infections after liver transplantation

目的评价髓样细胞触发受体(triggering receptor expressed on myeloid cells,TREM)-1用于监测肝移植术后感染的价值。方法 27例肝移植术后患者按临床转归分为非感染组(11例)、感染好转组(8例)和感染非好转组(8例)。比较三组在转入ICU48h内以及感染好转组和感染非好转组感染后48h内的外周血TREM-1、肿瘤坏死因子(tumor necrosis factor,TNF)-α、乳酸水平变化。应用Pearson相关分析或Spearman等级相关分析来研究TREM-1与另两种指标的相关性,对有相关的指标利用受试者工作特征(receiver operating characteristic,ROC)曲线求出各指标的灵敏度及特异度。结果三组的TREM-1、TNF-α、乳酸组间各个时间点比较,差异均具有统计学意义(均为P<0.05),且表达水平为感染非好转组>感染好转组>非感染组。感染好转组与感染非好转组的外周血TREM-1水平在发生感染前呈上升趋势,前组幅度平缓,后者升幅较大,且感染好转组外周血TREM-1水平于感染24h(高峰)后下降,而感染非好转组则持续升高。TREM-1与TNF-α、乳酸水平均呈正相关(均为P<0.01)。三项指标之中,TREM-1灵敏度、特异度较高。结论监测转入ICU48h内的TREM-1水平可对肝移植术后患者的感染情况起到预警作用,TREM-1表达水平与肝移植术后患者感染的严重程度一致,可预测病情转归。

Objective To evaluate the value of triggering receptor expressed on myeloid cells（TREM）-1 in monitoring infections after liver transplantation.Methods Twenty-seven patients were divided into three groups：group without infection（n=11）,infection group with improvement（n=8）,and infection group without improvement（n=8）according to the clinical conditions.The expression of TREM-1,tumor necrosis factor（TNF）-α and lactic acid of arterial blood were measured during the first 48 hours after patients moving into intensive care unit（ICU）as well as the first 48 hours of patients suffer from infection.The correlation between TREM-1 and the other two indicators was analyzed by Pearson or Spearman correlation analysis.The sensitivity and specificity of the indicators were analyzed by receiver operating characteristic（ROC）curve.Results There were significant differences of TREM-1,TNF-α and lactic acid in all three groups at different time-points（all in P0.05）.And the expression level of infection group without improvement was highest while that of group without infection was lowest.Both infection groups showed elevated TREM-1 level before infection occurrence.The ascent trend of TREM-1 was lower in infection group with improvement compared with that in the infection group without improvement.Decrease of TREM-1 level was also observed in infection group with improvement after infected 24 h while continuous increase was observed in infection group without improvement.The TREM-1 level was positively correlated with TNF-α and lactate acid levels（all in P0.01）.Among the tested indicators,the sensitivity and specificity of TREM-1 were higher than the others.Conclusions The expression level of TREM-1 at rolling in ICU is an early warning factor for monitoring to the infection of patients after transplantation.The expression of TREM-1 proved to be consistent with the severity of infection in the patients after liver transplantation and can be used to predict the prognosis of infection.