动态监测血清可溶性髓样细胞触发受体1对脓毒症的诊断及预后评估价值

Value of Dynamic Serum sTREM-1 in Diagnosing Sepsis,Severity Assessment,and Prognostic Prediction

目的探讨血清可溶性髓样细胞触发受体1（sTREM-1）水平对脓毒症的临床诊断及预后的价值。方法选取58例首诊为全身炎症反应综合征（SIRS）的患者，分为脓毒症组（40例）和非脓毒症组（18例），另选健康成年人作为对照组（12例）。采用ELISA法动态测定患者1、3、7、14d的血清sTREM-1、IL-6、IL-10的水平。再按28d转归将脓毒症40例分为生存组（27例）和死亡组（13例），利用APACHEU评分和SOFA评分评估脓毒症的危重程度，并分析sTREM-1与IL-6、IL-10、病情发展及预后的相关性。结果脓毒症组第1d血清sTREM-1、IL-6及IL-10的水平[分别为217．28（136．02-377．01）pg／mL、218．76（123．32-548．58）pg／mL及93．86（54．23-143．10）pg／mL]，均显著高于非脓毒症组[分别为55．51（39．50-77．33）og／mL、75．98（34．89-141．03）pg／mL及52．49（45．66-56．72）pg／mL]和正常对照组[分别为43．99（36．28-53．81）pg／mL、46．07（40．23-53．72）pg／mL及49．79（43．31-53．14）pg／mL]（P均〈0．01）。根据ROC曲线分析，sTREM-1对脓毒症和非脓毒症组进行诊断的曲线下面积（AUC）为0．82（95％C1 0．70-0．94）。在入组观察期间的1、3、7d，生存组的血清sTREM．1水平和IL-10水平随时间推移逐渐下降，死亡组sTREM1水平随时间推移呈显著上升趋势，且第14d死亡组的sTREM-1、IL-6、IL-10及IL-6／IL-10比值均显著高于生存组（P〈0．05）。脓毒症患者第1d血清sTREM-1水平与APACHEⅡ评分、SOFA评分、IL-6、IL-10及IL-6／IL-10均呈正相关（r分别为0．624、0．584、0．454、0．407及0．324，P均〈0．05）。Logistic回归分析显示，血清sTREM一1水平可作为脓毒症预后的危险因素，但并非独立的危险因素。结论血清sTREM-1水平有助于脓毒症的诊断，sTREM-1参与脓毒症的全身炎症反应过程，对脓毒症预后评估具有一定价值。

Objective To investigate the clinical value of soluble triggering receptor expressed on myeloid cell-1 （ sTREM-1 ） for diagnosis and prognosis of sepsis. Methods Patients with SIRS （ n = 58 ） were divided into a sepsis group （n = 40 ） and a non-sepsis group （n = 18 ）, and 12 healthy adults were admitted as control. Serum concentrations of sTREM-1, interleukin-6 （IL-6） and IL-10 were measured on days 1,3,7 and 14 by ELISA. According to the survival on 28th day after admission,the sepsis group was divided into survivors （ n = 27 ） and non-survivors （ n = 13 ）. APACHE 11 score and SOFA score were used to evaluate the severity of sepsis. The correlations between sTREM-1 and IL-6, IL-10, disease progression or prognosis were analyzed respectively. Results On the first day of enrollment, sTREM-1, IL-6 and IL-10 [ 217. 28 （ 136.02-377. 01 ） pg/mL, 218.76 （ 123.32-548.58 ） pg/mL and 93.86 （ 54. 23-143. 1 ） pg/mL, respectively ] in the sepsis group were significantly higher than those in the non-sepsis group [ 55. 51 （39. 50- 77.33） pg/mL, 75. 98 （34. 89-141.03） pg/mL and 52. 49 （45. 66-56. 72） pg/mL,respectively] and the control group [43. 99（36. 28-53. 81 ） pg/mL,46. 07（40. 23-53.72） pg/mL and 49. 79（43. 31-53. 14） pg/mL,respectively] （All P 〈 0. 01 ）. For diagnosis of sepsis, the area under the curve （AUC） for sTREM-1 was 0. 82 （95% C10. 70-0. 94）. Levels of sTREM-1 and IL-10 in survivors of sepsis were gradually increased on 1 ^st, 3^ rd ,7^th day of enrollment, while level of sTREM-1 in non-survivors showed an obvious decrease during the observation. On the 14^th of admission, sTREM-1, IL-6,IL-10 and IL-6/IL-10 ratio of non-survivors were significantly higher than those of survivors （ P 〈 0. 05 ）. There were significantly positive correlations between sTREM-1 and APACHE II score, SOFA score, IL-6, IL-10 or IL-6/IL-10 ratio （ r =0. 624,0. 454,0. 407 and 0. 324,respectively,all P 〈 0.05 ）. Logistic regression analysis indicated that serum level of sTREM-1 may be used as a prognostic factor of sepsis, but not an independent risk factor. Conclusion Serum sTREM-1 could be used as a marker to detect sepsis early, and sTREM-1 is also involved in systemic inflammatory reaction of sepsis patient and appears to be a prognostic value of sepsis.