降钙素原、髓系细胞表达的触发受体-1联合临床肺部感染评分对呼吸机相关性肺炎的早期诊断价值

Study on the clinical value of the combination of procalcitonin and triggering receptor expressed on myeloid cells-1and clinical pulmonary infection score in the early diagnosis of ventilator-associated pneumonia

目的:探讨降钙素原(PCT)、髓系细胞表达的触发受体-1(TREM-1)联合临床肺部感染评分(CPIS)对呼吸机相关性肺炎(VAP)早期诊断的临床意义。方法:采用前瞻性观察性研究方法,以78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、3、7天采集外周血及肺泡灌洗液标本并进行检测,同时进行CPIS,根据治疗后评估,将78例患者分为VAP确诊组(45例)与非VAP确诊组(33例),应用ROC曲线评价PCT、TREM-1、CPIS联合指标对VAP的早期诊断价值。结果:两组的PCT、TREM-1、CPIS差异有统计学意义(P<0.01)。第3天联合指标的诊断效能最高,PCT、TREM-1、CPIS联合指标对诊断VAP的敏感性、特异性、阳性预测值、阴性预测值分别为80.4%、100.0%、93.5%、100.0%。结论:结合PCT、TREM-1、CPIS综合分析可以显著提高诊断的特异性,对VAP的早期诊断有较好的实用性。

Objective： To explore the clinical value of the combination of procalcitonin（ PCT） and triggering receptor expressed on myeloid cells-1（ TREM-1） and clinical pulmonary infection score（ CPIS） in the early diagnosis of ventilator-associated pneumonia（ VAP）. Methods： A prospective observational study was conducted.A total of 78 patients with mechanical ventilation treatment were recruited and the levels of PCT and TREM-1 and CPIS were detected or evaluated on the first day,third day and seventh day of the end of treatment. All subjects were divided into VAP group（ 45 cases） and Non-VAP group（ 33 cases）. The early diagnostic value was assessed by ROC curve analysis. Results： The PCT and TREM-1 and CPIS showed significant differences between the VAP group and Non-VAP group（ all P〈0. 01）. The ROC results showed that the sensitivity,specificity,positive predictive rates,negative predictive rates of the combination index of PCT and TREM-1 and CPIS were 80. 4%,100. 0%,93. 5%,100. 0%. Conclusion： The combination index of PCT and TREM-1 and CPIS can significantly improve the specificity of the early diagnosis of VAP,which means that the combination index is practical in diagnosing VAP.