呼出气冷凝液中可溶性髓系细胞触发受体-1检测对呼吸机相关性肺炎早期诊断的价值

Clinical value of soluble triggering receptor expressed on myeloid cells-1 in the early diagnosis of patients with ventilator-associated pneumonia

目的探讨呼吸机呼出气冷凝液(EVC)中可溶性髓系细胞触发受体-1(sTREM-1)对呼吸机相关性肺炎(VAP)早期诊断的临床意义。方法以37例有创机械通气患者为研究对象,所有患者均在机械通气后第1 d、3 d、7 d应用双抗体夹心酶联免疫吸附法(DAS-ELISA)测定EVC中sTREM-1水平,根据治疗后评估,37例患者被分成非VAP组13例,VAP组24例(其中康复组14例,恶化组10例),应用受试者工作特征曲线(ROC)研究EVC sTREM-1对VAP早期诊断价值。结果第3 d,VAP组血清CRP、EVC sTREM-1均高于非VAP组(P<0.01);与康复组比较,恶化组血清CRP及EVC sTREM-1水平明显升高(P<0.01);第7 d,血清CRP和EVC sTREM-1在恶化组仍处较高水平,与康复组、非VAP组比较,差异有统计学意义(P<0.01),而康复组与非VAP组在第7 d比较无差别(P>0.05)。应用ROC分析,以第3 d EVC sTREM-1 4.70 ng/ml为VAP的早期诊断界值,其敏感度为95.8%,特异度为92.3%。结论连续EVC中sTREM-1检测有助于VAP的早期诊断,而第7 d血清CRP和EVC中sTREM-1水平可能有助于判断VAP的预后(撤机失败和死亡)指标之一。

Objective To discuss the value of soluble triggering receptor expressed on myeloid cells-1 （ sTREM-1 ） in exhaled ventilator condensate （EVC） in the early diagnose of patients with ventilator-associated pneumonia （VAP）. Methods sTREM-1 in EVC was determined in 37 adult patients with mechanical ventilation treatment by double antibody sandwich enzyme-linked immunosorbant assay （ DAS-ELISA）. The 37 patients were divided into the non-VAP group with 13 cases and the VAP group with 24 cases, and the VAP group included the recovery subgroup （ 14 cases） and the aggravation subgroup （ 10 cases）. The levels of sTREM-I in EVC was measured on Day 1, 3 and 7 for all patients. The early diagnostic value was assessed by receiver operating characteristic （ROC） curve analysis. Results On the 3th day, the levels of EVC, sTREM-1 and serum CRP were obviously higher in the VAP group than in the non-VAP group （P 〈 0.01 ）. On the 7th day, the levels of EVC, sTREM-1 and serum CRP were still higher in the aggravation subgroup than in the recovery subgroup and the non-VAP group （P 〈 0. 01 ）, but there was no significant difference between the non-VAP group and the recovery sub- group （P 〉0. 05）. The dividing value of sTREM-1 in the early diagnosis of patients with VAP was 4.70 ng/ml on the 3rd day by ROC curve analysis. The sensitivity was 85.8% , and the specificity was 92.3%. Conclusion The results suggest that the levels of sTREM- 1 in EVC is conducive to the early diagnosis of VAP, and the levels of sTREM-1 in EVC and serum CRP are helpful to estimate the prog- nosis on the 7th day, including ventilator weaning failure and death.