支气管肺泡灌洗液可溶性髓样细胞触发受体1对创伤后急性呼吸窘迫综合征患者肺部感染的早期诊断价值

Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid cells-1 in Bronchoalveolar Lavage Fluid for Early Pulmonary Infection in Patients with Post-traumatic ARDS

目的评价创伤后急性呼吸窘迫综合征(ARDS)患者支气管肺泡灌洗液(BALF)中可溶性髓样细胞触发受体1(sTREM-1)水平对创伤后ARDS患者并发肺部感染的早期诊断价值。方法选择2010年1月至2013年6月从深圳沙井医院急诊科或其他创伤外科等科室转入重症加强治疗病房(ICU)的创伤后ARDS患者64例,根据是否合并肺部感染分为肺感染组(34例)和非肺感染组(30例)。选择30例18岁以上健康志愿者的血清和BALF标本作为正常对照。结果正常对照组、肺感染组和非肺感染组的性别构成和年龄差异无统计学意义(P>0.05)。肺感染组与非肺感染组之间创伤严重程度评分(ISS)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、28 d死亡率、氧合指数(PaO2/FiO2)、气管插管时间、机械通气时间和ICU住院时间的差异有统计学意义(P<0.01)。与正常对照组比较,肺感染组和非肺感染组的血清C反应蛋白(CRP)、降钙素原(PCT)和sTREM-1水平显著升高(P<0.001);肺感染组血清CRP、PCT、sTREM-1水平和BALF中sTREM-1水平较非肺感染组显著升高(P<0.05)。ROC曲线分析CRP、PCT和sTREM-1水平对创伤后ARDS患者肺感染的诊断价值:血清CRP曲线下面积(AUC)为0.67,敏感度为0.68,特异度为0.70;血清PCT的AUC为0.67,敏感度为0.70,特异度为0.64;血清sTREM-1的AUC为0.73,敏感度为0.73,特异度为0.68;BALF中sTREM-1的AUC为0.90,敏感度为0.88,特异度为0.82。结论 BALF中sTREM-1可作为早期诊断创伤后ARDS患者并发肺部感染的指标,其敏感度和特异度高于血清CRP、PCT和sTREM-1。

Objective To evaluate the diagnostic value of sTREM-1 level in bronchoalveolar lavagefluid （ BALF） for diagnosing early lung infection of patients with post-traumatic acute respiratory distresssyndrome.Methods 64 patients with post-traumatic ARDS, who were admitted in ICU from emergencydepartment or other trauma surgery department from January 2010 to December 2012, were divided into apulmonary infection group （ n = 34） and a non-pulmonary infection group（ n = 30） . 30 healthy volunteersaged over 18 years were taken as healthy control group. The ROC curve was used to analyze the diagnosticvalue of C-reactive protein （ CRP） , procalcitonin （ PCT） and sTREM-1 in early pulmonary infection of patientswith post-traumatic ARDS.Results Gender and age composition showed no significant difference among thehealthy control group, the pulmonary infection group, and the non-pulmonary infection group （ P 〉0. 05） .Injury severity scale（ ISS） , APACHEⅡ and the mortality in 28 days showed significant difference betweenthe groups of pulmonary infection and non-pulmonary infection（ P 〈 0. 05） . Oxygenation index （ PaO2 /FiO2 ） , tracheal intubation time, mechanical ventilation time and length of ICU stay also showed significantdifference between the groups of pulmonary infection and non-pulmonary infection（ P 〈 0. 01） . Comparedwith the healthy control group, levels of serum CRP, PCT and sTREM-1 increased significantly in the groupsof pulmonary infection and non-pulmonary infection（ P 〈0. 001） . Compared with the non-pulmonary infectiongroup, the levels of CRP, PCT and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in thepulmonary infection group （ P 〈0. 05） . The area under the ROC curve （ AUC） of serumCRP was 0. 67 withthe sensitivity of 0. 68 and the specificity of 0. 70. AUC of serum PCT was 0. 67 with the sensitivity of 0. 70and the specificity of 0. 64. AUC of serumsTREM-1 was 0. 73 with the sensitivity of 0. 73 and the specificityof 0. 68. AUC of sTREM-1 in BALF was 0. 90 with the sensitivity of 0. 90 and the specificity of 0. 82.Conclusions sTREM-1 in BALF can be used as a diagnostic indicator for early pulmonary infection in patientswith post-traumatic ARDS. Its sensitivity and specificity are higher than serumCRP, PCT and sTREM-1.