可溶性髓样细胞触发受体1对呼吸机相关性肺炎临床诊断价值的研究

Clinical Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Ventilator-Associated Pneumonia

目的观察气管内抽吸物和血浆中可溶性髓样细胞触发受体1(sTREM-1)对呼吸机相关性肺炎(VAP)的临床诊断价值。方法纳入68例VAP患者为VAP组,50例接受机械通气但无VAP的患者为非VAP组,50例健康者为对照组。采用夹心酶联免疫吸附测定法(ELISA)检测受试者血浆sTREM-1、气管内抽吸物sTREM-1和血清高敏C反应蛋白(hs-CRP)浓度,计算各指标诊断VAP的敏感度和特异度。结果 VAP组治疗前血浆sTREM-1、气管内抽吸物sTREM-1水平均显著高于非VAP组[(143.62±46.82)pg/mL比(68.56±16.24)pg/mL,(352.86±92.57)pg/mL比(126.21±42.28)pg/mL,P<0.05],治疗第3 d和第7 d的血浆sTREM-1、气管内抽吸物sTREM-1水平显著降低(P<0.05)。ROC曲线分析显示气管内抽吸物中sTREM-1浓度193.64 pg/mL可作为VAP合理的诊断浓度阈值(敏感度为93.84%,特异度为89.51%,ROC曲线下面积为0.912),其诊断价值优于血浆sTREM-1浓度(ROC曲线下面积为0.768)和血清hs-CRP浓度(ROC曲线下面积为0.704)。结论sTREM-1可作为VAP患者疗效判断的参考指标。气管内抽吸物中sTREM-1对VAP的诊断价值优于血浆sTREM-1和血清hs-CRP。

Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1（sTREM-1） in endotracheal aspirate and plasma of patients with ventilator-associated pneumonia（VAP）.Methods The consentration of sTREM-1 in plasma and endotracheal aspirate,and serum high-sensitivity C-reactive protein（hs-CRP） were measured by enzyme-linked immunosorbent assay（ELISA） in 68 patients with VAP（VAP group）,50 patients underwent ventilation without VAP（non-VAP group）,and 50 healthy individuals（control group）.The sensitivity and specificity of each parameter were calculated.Results In the patients with VAP,sTREM-1 in plasma and endotracheal aspirate before treatment were significantly higher than that in the non-VAP group [（143.62±46.82） pg/mL vs.（68.56±16.24）pg/mL,（352.86±92.57）pg/mL vs.（126.21±42.28）pg/mL,P〈0.05];sTREM-1 in plasma and endotracheal aspirate on the 3rd and the 7th day during treatment were significantly decreased（P〈0.05）.By ROC analysis,the cut-off value of sTREM-1 in endotracheal aspirate were 193.64 pg/mL,with sensitivity and specificity of 93.84% and 89.51% respectively.The areas under ROC curve of sTREM-1 in endotracheal aspirate were 0.912.Clinical diagnostic value of sTREM-1 in endotracheal aspirate was better than plasma sTREM-1 and serum hs-CRP（areas under ROC curve were 0.768 and 0.704 respectively）.Conclusions sTREM-1 may be helpful for evaluating the therapeutic effect in patients with VAP.The diagnostic value of sTREM-1 in endotracheal aspirate may be superior to plasma sTREM-1 and serum hs-CRP.