可溶性髓系细胞触发受体-1和可溶性血红蛋白清道夫受体对脓毒症的诊断价值

The value of sTREM-1 and sCD163 in the diagnosis of sepsis

目的探讨可溶性髓系细胞触发受体-1(sTREM-1)、可溶性血红蛋白清道夫受体(sCD163)等指标对诊断脓毒症及评估脓毒症严重程度的价值,为临床脓毒症的诊断及治疗提供可靠依据。方法 70例入住ICU时疑似脓毒症的患者,按2001年脓毒症诊断标准分为脓毒症组(A组,n=51)和非脓毒症组(B组,n=19)。脓毒症组(A组)再按病情严重程度分为一般脓毒症组(A1组,n=19)、严重脓毒症组(A2组,n=19)和脓毒症休克组(A3组,n=13)3个亚组。另收集20例健康体检者作为对照组(C组)。A组患者分别于入住ICU第1、3、7天(B组仅在第1天,C组在体检时)采集外周血,ELISA方法检测sTREM-1和sCD163表达水平,并送检验科检测降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC)。结果 A组患者第1天sTREM-1、sCD163、PCT表达水平均显著高于B组(P<0.01),但两组间CRP水平差异无统计学意义(P=0.116)。亚组相同时间点比较,A2组第1、3天sTREM-1和第1、3、7天sCD163水平均显著高于A1组(P<0.05);A3组第1、3、7天sTREM-1、sCD163、PCT水平均显著高于A1组(P<0.05);A2组第1、3、7天PCT水平与A1组比较差异无统计学意义(P>0.05)。sTREM-1与sCD163呈显著正相关(r=0.632)。sTREM-1、sCD163s、sTREM-1+sCD163(串联)诊断脓毒症的AUC分别为0.911、0.913、0.934,均显著高于PCT、CRP和WBC。结论 sTREM-1、sCD163、PCT等指标均能敏感反映机体脓毒症状态,sTREM-1和sCD163显著优于PCT、CRP、WBC等指标,且两者呈显著正相关关系,表明sTREM-1+sCD163(串联)可作为诊断脓毒症的可靠指标。

Objective To analyze the application of sTREM-1 and sCD163 in the diagnosis and severity evaluation of sepsis.Methods A total of 70 patients,who were suspected sepsis when admitted to the ICU,were divided into sepsis group（Group A,n=51） and non-sepsis group（Group B,n=19） according to 2001 sepsis diagnosis criteria.The subjects in sepsis group（Group A） were subdivided into three sub-groups,such as general sepsis group（Group A1,n=19）,severe sepsis group（Group A2,n=19） and septic shock group（Group A3,n=13） according to the severity of the disease.Twenty healthy people were enrolled as the control group（Group C,n=19）.Peripheral blood of patients in Group A was collected on Day 1st,3rd,and 7th,while in Group B on Day 1st and in Group C at physical examination.The expression of sTREM-1 and sCD163 was assessed by ELISA,whereas procalcitonin（PCT）,C-reactive protein（CRP） and white blood cell count（WBC） were measured in clinical laboratory.Results The expression of sTREM-1,sCD163 and PCT in Group A was significantly higher than that in Group B（P0.01） on Day 1st,while there was no significant difference revealed in CRP between the two groups（P=0.116）.The sTREM-1 on Day 1st,3rd and sCD163 on Day 1st,3rd,7th in Group A2 were significantly higher than those in Group A1（P0.05）.The sTREM-1,sCD163 and PCT on Day 1st,3rd,7th in Group A3 were significantly higher than those in Group A1（P0.05）.However,there was no significant difference in PCT between Group A2 and Group A1（P0.05）.There was significantly positive correlation between sTREM-1 and sCD163（r=0.632）.According to the ROC of sepsis diagnosis,The AUCs of sTREM-1,sCD163 and sTREM-1＋sCD163 were 0.911,0.913 and 0.934,respectively,which were all higher than PCT,CRP or WBC.Conclusion It is sensitive to use sTREM-1,sCD163,PCT in sepsis diagnosis and evaluation.Among them sTREM-1 and sCD163 are superior to PCT CRP,and WBC.The sTREM-1 is significantly associated with sCD163,thus providing reliable indicator in the clinical diagnosis of sepsis.