血清可溶性髓系细胞触发受体-1检测在细菌性肺炎诊断中的意义

Value of soluble triggering receptor expressed on myeloid cells-1 in diagnosis of bacterial pneumonia

目的:检测细菌性肺炎患者外周血可溶性髓系细胞触发受体-1(sTREM-1)的水平,观察sTREM-1对诊断细菌性肺炎的意义。方法:应用双抗体夹心酶联免疫吸附法(ELISA)检测75例细菌性肺炎患者及72例正常健康体检者血清sTREM-1、降钙素原(PCT)、C反应蛋白(CRP)的水平。应用受试者工作特征(ROC)曲线研究sTREM-1的诊断效力。对肺炎组进一步进行亚组分析,并将sTREM-1水平与临床肺部感染评分(CPIS)进行相关性分析。结果:细菌性肺炎患者血清sTREM-1水平为(9.89±6.13)ng/mL,较对照组[(3.37±1.67)ng/mL]显著升高(P=0.001)。根据ROC曲线,sTREM-1取>4.46ng/mL为临界值,其曲线下面积为0.811,诊断细菌性肺炎的灵敏度为70.7%,特异度为76.4%,阳性预测值为75.7%,阴性预测值为71.4%,准确率为73.5%,诊断效能中等。肺炎组中重症肺炎患者血清sTREM-1为(12.65±6.37)ng/mL,较非重症患者[(9.14±5.91)ng/mL]水平增高,差异有统计学意义(P<0.05)。肺炎组患者sTREM-1水平与CPIS评分呈正相关(P<0.05)。结论:测定细菌性肺炎患者血清sTREM-1水平对于细菌性肺炎的诊断有一定价值。重症肺炎患者血清sTREM-1水平升高,且与CPIS评分相关,提示sTREM-1与感染严重程度相关。

Objective To investigate the value of soluble triggering receptor expressed on myeloid cells-1（sTREM- 1） in the diagnosis of bacterial pneumonia. Methods Serum sTREM-1, PCT, CRP levels were determined in 75 patients with bacterial pneumonia and 72 normal controls by enzyme-linked immunosorbent assay （ELISA）. The diagnostic value was assessed by receiver operating characteristic （ROC）curve analysis. Subgroup analysis was performed in pneumonia patients. The correlation between level of serum sTREM-1 and clinical pulmonary infection score （CPIS） was analyzed. Results Level of serum sTREM-1 was significant higher in pneumonia group than in the normal control group [（9.89± 6.13） ng/mL vs （3.37±1.67） ng/mL,P=0.001].For ROC curve, when the cut-off value of sTREM-1 was set at 4.46 ng/mL, the sensitivity was 70.7%, specificity was 76.4%, positive predictive value was 75.7% and negative predictive value was 71.4%. In pneumonia group, sTREM-1 level increased significantly in severe pneumonia than non-severe pneumonia [（12.65±6.37） ng/mL vs （9.14±5.91） ng/mL, P0.05]. In pneumonia group, sTREM-1 level correlated positively with CPIS （P0.05）. Conclusions Detection of serum sTREM-1 is helpful in the diagnosis of bacterial pneumonia. sTREM-1 level is higher in severe pneumonia and has a positive correlation with CPIS. Serum sTREM-1 level could help to evaluate the severity of infection.