医院获得性肺炎患者血浆、呼出气冷凝液中可溶性髓样细胞触发受体水平变化及意义

Change of detecting the levels of souble triggering receptor expressed on myeloid cell-1 in plasma and exhaled breath condensate of hospital-acquired pneumonia patients and its significance

目的探讨医院获得性肺炎(HAP)患者血浆、呼出气冷凝液(EBC)中可溶性髓样细胞触发受体-1(sTREM-1)水平变化及意义,为指导HAP的临床治疗提供理论依据。方法将30例HAP诊断标准的患者分为两组,重症HAP组15例(存活7例,死亡8例),轻中症HAP组15例;设对照组15例进行对比。HAP组和对照组均收集第1、7天血浆和EBC标本,用酶联免疫吸附法(ELISA)检测血浆和EBC中sTREM-1水平,记录所有受试者血浆中C反应蛋白(CRP)水平及评估HAP患者临床肺部感染评分(CPIS)情况。结果 1第1天重症HAP组血浆、EBC中sTREM-1水平分别为126.25±26.96 ng/L、194.45±31.89 ng/L显著高于轻中症HAP组(69.03±11.28 ng/L、129.12±19.58 ng/L,P<0.01),显著高于对照组(40.13±17.19 ng/L,99.09±14.10 ng/L,P<0.01),第1天轻中症HAP组各个指标均分别显著高于对照组(P<0.01)。轻中症HAP组经治疗后血浆及EBC中sTREM-1呈下降趋势;2重症HAP存活亚组经治疗后血浆、EBC中sTREM-1呈下降趋势,第7天血浆及EBC中sTREM-1水平分别为(72.15±24.75 ng/L、125.87±20.58 ng/L)显著低于第1天(126.51±26.97 ng/L、192.91±32.53 ng/L,P<0.01)。重症HAP死亡亚组血浆中sTREM-1呈上升趋势,第7天血浆中sTREM-1水平(174.37±39.73 ng/L)显著高于第1天(125.97±29.09 ng/L,P<0.01),EBC中sTREM-1有上升趋势,但差异无统计学意义;3血浆sTREM-1的浓度与CPIS评分成正相关(r=0.718,P<0.01),CRP与CPIS评分成正相关(r=0.689,P<0.01),EBC中sTREM-1与CPIS有相关趋势但不明显(r=0.486,P<0.05)。结论血浆和EBC中sTREM-1水平作为诊断HAP有较好的参考价值,血浆sTREM-1及CRP水平能够反应HAP的严重程度,动态监测血浆中sTREM-1及CRP水平变化情况,有利于评估治疗效果和判断预后。

Objective To investigate the value of soluble triggering receptor expressed on myeloid cell- 1 （ sTREM-1 ） in diagnosis and the relationship between some biomarkers and the severity of hospital-acquired pneumonia （HAP）, by detecting the levels of sTREM-1 in plasma and exhaled breath condensate （EBC） of HAP patients, to provide theoretical basis for HAP elinical treatment. Methods Thirty HAP patients and fifteen control subjects took part in this study： The HAP patients were divided into two groups： fifteen acquired severe HAP （seven cases were alive, eight have been dead） , fifteen were mild or moderate HAP. Plasma and EBC were collected in patients and control subjects. It was collected that plasma and EBC on the first day and the seventh day in HAP group and control group. The levels of sTREM-1 was detected in Plasma and EBC using enzyme linked immunosorbent assey （ELISA）. The levels of plasma C-reactive protein （CRP） in all subjects and the clinical pulmonary infection score （CPIS） of HAP patients were recorded. Results ①The sTREM-1 levels in plasma and EBC of severe HAP patients on the first day （ 126.25 ± 26.96 ng/L, 194.45 ± 31.89 ng/ L） were much higher than those of the mild or moderate HAP patients （69.03 ± 11.28 ng/L, 129.12 ± 19.58 ng/L, P 〈 0.01 ） and were much higher than those of the control subjects（40.13 ± 17.19 ng/L, 99.09 ＋ 14.10 ng/L, P 〈0.01 ）. The sTREM-1 levels in plasma and EBC of mild or moderate HAP patients on the first day were also much higher than those of the control subjects （ P 〈 0.01 ）. The levels of sTREM-1 in plasma and EBC of mild or moderate HAP patients after treatment trended down; ③The levels of sTREM-1 in plasma and EBC of survival subgroup of severe HAP patients after treatment trended down, the sTREM-1 levels in plasma and EBC on the seventh day （72.15±24.75 ng/L,125.87 ±20.58 ng/L） much lower than those on the first day（ 126.51 ±26.97 rig/L, 192.91 ±32.53 ng/L, P 〈 0.01 ）. The levels of sTREM-1 in plasma and EBC of death subgroup of severe HAP patients was on the rise, the sTREM-1 levels in plasma and EBC on the seventh day （ 174.37 ＋39.73 ng/L,266.86 ＋27.02 ng/L） much higher than those on the first day（ 125.97 ~29.09 ng/L, 224.83 ±5.92 ng/L, P 〈0.01 ）. The sTREM-1 levels of EBC had a rising trend, but the difference was not statistically significant; @The level of sTREM-1 in plasma was correlated positively to the CPIS （ r = 0. 718, P 〈0. 01 ）. The level of CRP in plasma was correlated positively to the CPIS（ r =0. 689, P 〈0. 01 ）, the other biomarkers （plasma PCT and EBC sTREM-1 ） and CPIS had a correlated trend but not obvious （r = 0. 486, P 〈 0.05 ）. Conclusions The levels of sTREM-1 in plasma and EBC has a good reference value for the diagnosis of HAP. The levels of sTREM-1 in plasma are relative to the severity of pneumonia. Dynamic monitoring of levels of sTREM-1 and CRP in plasma, it is helpful to evaluate the therapeutic effect and estimating prognosis.