可溶性髓细胞触发受体-1对呼吸机相关性肺炎的早期诊断价值

Early diagnostic value of soluble triggering receptor expressed on myeloid cells1 in patients with ventilator associated pneumonia

目的 探讨可溶性髓系细胞触发受体-1 （sTREM-1）表达对呼吸机相关性肺炎（VAP）早期诊断价值.方法 前瞻性观察研究,收集浙江省人民医院重症监护病房（ICU） 2008年1月至2010年12月期间收治的机械通气前无肺部感染,使用机械通气48 h后出现发热,气管支气管内分泌物增多,临床疑诊VAP患者112例.排除机械通气时已有肺部感染或机械通气时间≤48 h者.由两位ICU专家在不知道sTREM-1情况下根据临床及微生物培养结果来确诊有无VAP,根据是否合并VAP,分为VAP组（n=74）和非VAP组（n=38）.在临床疑诊当天通过微支气管肺泡灌洗技术获取其BALF液体并抽取静脉血,采用酶联免疫吸附试验（ELSIA）方法检测BALF和血清中sTREM-1水平.统计学分析采用SPSS 16.0软件,采用t检验来比较VAP组与非VAP组疑诊当天BALF、血清sTREM-1水平,并通过绘制受试者工作特征曲线（ROC）计算敏感性、特异性及曲线下面积来分析sTREM-1对VAP早期诊断价值.结果 VAP患者临床疑诊当天BALF、血清sTREM-1水平分别为（232.72±83.71） pg/mL和（134.32±47.97）pg/mL,明显高于非VAP组,后者BALF、血清sTREM-1水平分别为（124.31±52.95）pg/mL和（71.14 ±36.46） pg/mL,差异具有统计学意义（P＜0.01）.绘制ROC曲线,显示BALF中sTREM-1水平153.18 pg/mL时,诊断VAP有最佳的敏感性和特异性,分别为86.49％和84.21％；血清sTREM-1为98.40 pg/mL时,诊断VAP的敏感性为77.03％,特异性为73.68％.结论 对新临床疑诊VAP的患者检测BALF和血清sTREM-1水平有利于早期诊断VAP.

Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 （sTREM-1） in patients with ventilator associated pneumonia （VAP）.Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia （VAP） patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups：VAP group （n =74） and non-VAP group （n =38）.The levels of sTREM-1 in broncho-alveolar lavage fluid （BALF） collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay （ELISA） on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic （ROC） curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups：VAP group （n =74） and non-VAP group （n =38）.The levels of sTREM-1 in broncho-alveolar lavage fluid （BALF） collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay （ELISA） on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic （ROC） curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.