可溶性髓样细胞触发受体-1和可溶性血红蛋白清道夫受体水平在重症肺炎诊断和预后判断中的价值

Value of s TREM-1 and sCD163 in the diagnosis and prognosis of severe pneumonia patients

目的探讨诱导痰可溶性髓样细胞触发受体-1（s TREM-1）与可溶性血红蛋白清道夫受体（s CD163）的水平在重症肺炎的诊断和预后中的临床意义。方法选取2013年6月-2014年8月广东省佛山市顺德区桂洲医院收治的45例重症肺炎患者、20例普通肺炎患者、20例健康对照人群,入组当天用双抗体夹心酶联免疫吸附法（ELISA）测定三组诱导痰的s TREM-1和s CD163水平。检测重症肺炎患者中存活组和死亡组入组第1、4、7天,出院或死亡当天诱导痰s TREM-1、s CD163水平。应用受试工作特征ROC曲线研究s TREM-1、s CD163的诊断效能。结果重症肺炎患者入组后第1天诱导痰s TREM-1及s CD163水平均高于普通肺炎患者及正常对照组（P〈0.05）。重症肺炎存活组诱导痰s TREM-1、s CD163水平出院当天低于入组第1、4、7天（P〈0.05）;死亡组诱导痰s TREM-1、s CD163水平死亡当天高于入组第1、4、7天（P〈0.05）,同一时间点的指标水平均高于存活组（P〈0.05）。s TREM-1、s CD163、s TREM-1和s CD163联合检测对重症肺炎的诊断的曲线下面积分别为0.828、0.765、0.846。结论 s TREM-1、s CD163可能参与了重症肺炎的发病过程,在重症肺炎的早期诊断中有较高的价值,动态监测诱导痰s TREM-1、s CD163水平变化有助于判断重症肺炎的预后。

Objective To explore the diagnosis and prognosis of soluble triggering receptor expressed on myeloid cells-1（s TREM-1） and soluble hemoglobin scavenger receptor（s CD163） in induced sputum of severe pneumonia patients.Methods Induced sputum levels of s TREM-1 and s CD163 were determined by enzyme-linked immunosorbent assay（ELISA） on the day of admission in 45 patients with severe pneumonia, 20 patients with uncomplicated pneumonia and20 healthy controls, which received in Guizhou Hospital of Shunde District, Guangdong Province from June 2013 to August 2014. s TREM-1 and s CD163 induced sputum levels were measured in survival and non-survival severe pneumonia in the first, fourth, seventh day after entering the group, and the day of discharge or death. The diagnostic value of s TREM-1 and s CD163 were assessed by receiver operating characteristic（ROC） curve analysis. Results Induced sputum levels of s TREM-1 and s CD163 in the patients with severe pneumonia were higher than those with uncomplicated pneumonia and the healthy controls on the day of admission（P〈0.05）. The induced sputum levels of s TREM-1 and s CD163 in the survival patients with severe pneumonia group in the day of discharge were less than those in the first day, the fourth day and the seventh day（P〈0.05）. The induced sputum levels of s TREM-1 and s CD163 in non-survival severe pneumonia in the day of death were higher than those in the first day, the fourth day and the seventh day（P〈0.05）. On the same time points, the induced sputum levels of s TREM-1 and s CD163 of the non-survivors were higher than the survivors（P〈0.05）. The areas under the ROC curve of s TREM-1 and s CD163 for diagnosis of severe pneumonia were 0.828 and 0.765, the areas under the ROC curve of combination was 0.846. Conclusion The s TREM-1 and s CD163 maybe involved in the pathogenesis of severe pneumonia, and have great value in early diagnosis of severe pneumonia. It is helpful to determine the prognosis of severe pneumonia by dynamically monitoring the levels of s TREM-1 and s CD163 in induced sputum.