可溶性髓细胞触发受体-1在脓毒症诊断及病情判断的价值

Soluble triggering receptor expressed on myeloid cells - 1 were valuable in the diagnosis and assessment of severity of sepsis

目的 通过检测人血浆可溶性髓细胞触发受体-1（sTREM-1）水平,研究sTREM-1对脓毒症的诊断价值和在评估脓毒症严重程度及预后的意义.方法 将2010-05～2011-01收治的64例系统性炎症反应综合征（SIRS）患者,根据脓毒症诊断标准分为脓毒症组43例（脓毒症17例、严重脓毒症14例和脓毒性休克12例）、SIRS组（非感染）21例,根据28 d预后将脓毒症组分为存活组29例和死亡组14例.收集所有患者第1天的血浆,追踪留取脓毒症患者第1、4、7天的血浆,并记录对应时间的心率、白细胞计数、C反应蛋白（CRP）等临床数据.结果.患者入ICU第1天脓毒症组sTREM-1高于SIRS组[（147.28±58.32 pg/mL]比（81.61±24.57 pg/mL,P〈0.05）];sTREM-1的受试者特征操作曲线下面积高于降钙素原（PCT）、CRP、IPS评分;sTREM-1水平变化与APACHEⅡ评分变化呈正相关（rs=0.446,P=0.000）.sTREM-1水平在存活组则呈逐渐下降趋势,在死亡组随时间推移无明显变化趋势,死亡组sTREM-1于病程第4天起高于存活组同期对应指标（P＜0.05）.结论.检测血浆sTREM-1可作为脓毒症早期诊断的指标,在诊断上具有良好的敏感性和特异性,诊断价值优于PCT、CRP及IPS评分等指标;动态监测检测血浆sTREM-1能反映疾病的严重程度及预后.

Objective To investigate the diagnostic value of plasma soluble TREM - 1 for sepsis and assess the significance of severity and prognosis of the disease process. Methods Sixty four patients were enrolled if there was clinical suspicion of infection and they fulfilled at least two eriteria of SIRS to the Emergency and Medical Intensive Care Unit between May 2010 and January 2011. According to sepsis diagnostic criteria are divided into sepsis group（sepsisl7 cases, sever sepsis 14 cases septic shock 12 cases） ,nonbacterial systemic inflammation syndrome group（SIRS 17 cases）, Sepsis group was divided into two subgroups （survival group 29 cases, death group 14 cases） according to 28 - day prognosis. At days 1,4 and 7 after diagnosis, blood samples were collected in patients with sepsis,and the clinical data were also recorded, such as white blood cell （WBC）, C reactive protein （CRP）, procalcitonin（PCT） and so oi1. Results The plasma soluble TREM - 1 in the sepsis group group on the 1 st day were higher than in the SIRS group [ （147.28±58.32）pg/mL vs （81.61±24.57）pg/mL,P 〈 0.05 ]. The area under the receiver operating characteristic curve for the diagnosis of infection ofsTREM -1 was larger than that of PCT, CRP and IPS. A Positive correlation was observed between sTREM - 1 and APACHE lI score （ rs = 0. 446, P = 0. 000 ）. Plasma sTREM - 1 decreased in survival group and hold stationa,＇y in death group during the seven days period of study, and sTREM - 1 in survival group was higher than death group at the fourth and seventh day. Conclusion sTREM - 1 proved to be the better indicater than PCT, CRP or IPS of sepsis in newly admitted critically,which has a high sensitivity and specificity. Dynamical detection of plasma sTREM - 1 can reflect the severity and prognosis of disease.