可溶性髓系细胞触发受体-1在支气管肺泡灌洗液及呼出气冷凝液中的表达对呼吸机相关性肺炎的诊断价值研究

Soluble triggering receptor expressed on myeloid cells-1 as a diagnostic marker for ventilator-associated pneumonia

目的：探讨支气管肺泡灌洗液（bronchoalveolar lavage fluid,BALF）及呼出气冷凝液（exhaled breath condensate,EBC）中的可溶性髓系细胞触发受体-1（soluble triggering receptor expressed on myeloid cells 1,sTREM-1）含量,以及其在呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）诊断中的价值。方法：纳入2014年3所教学医院中疑似VAP的患者127例,于疑诊VAP当日及诊断VAP当日行纤维支气管镜肺泡灌洗,并检测BALF及EBC中s TREM-1的含量,经受试者工作特征（receiver operating characteristic,ROC）曲线选取最佳临界值,评估其诊断效价。结果：127例疑似VAP的患者中72例（56.69%）被诊断为VAP。于诊断当日检测VAP及非VAP患者BALF中的s TREM-1含量为58.06 pg/m L[四分位数间距（interquartile range,IOR）为40.45~70.71 pg/m L]和16.69 pg/m L（IOR为13.24~33.07 pg/m L）,而两者EBC中的s TREM-1含量分别为1.97 pg/m L（IOR为1.54~2.61 pg/m L）和0.56 pg/m L（IOR为0.26~1.59 pg/m L）,比较发现,VAP患者BALF及EBC中的s TREM-1含量均高于非VAP患者（P〈0.05）。诊断当日检测BALF中s TREM-1含量的ROC曲线下面积为0.917,且具有良好的诊断灵敏度（87.51%）和特异度（81.82%）,最佳临界值为37.11 pg/m L（P〈0.001）。结论：BALF及EBC中的sTREM-1含量对于VAP的诊断准确率较高,值得临床推广。

Objective： To investigate the potential role of soluble triggering receptor expressed on myeloid cells-1 （sTREM-1） in bronchoalveolar lavage fluid （BALF） and exhaled breath condensate （EBC） as an early biomarker for the di- agnosis of ventilator-associated pneumonia （VAP）. Methods： One hundred and twenty-seven consecutive patients with clinically suspected VAP were prospectively included in this muhicenter study. The levels of sTREM-1 in BALF and EBC at the time of VAP suspected （S Day） and VAP diagnosed （D Day） were analyzed for diagnostic evaluation. The receiver operating characteristic curve was used to determine the optimal cutoff value. Results： VAP was confirmed in 72（56.69%） cases. In patients with VAP, the median level （interquartile range, IQR） of sTREM-1 in BALF [58.06 （IQR, 40.45-70.71） vs16.69 （13.24-33.07）] pg/mL and in EBC [1.97 （IQR,1.54-2.61） vs 0.56（0.26-1.59）] pg/mL were higher than those in patients without VAP at D Day, respectively （P〈0.05）. The optimal cutoff value for sTREM-1 in BALF according to the maximum Youden index was 37.11 pg/mL at D Day. The sensitivity and specificity of this cutoff value for diagnosis of VAP were 87.51% and 81.82%, respectively, with a 0.917 area under the curve （P〈0.001）. Conclusions： It suggests that sTREM-1 measurement in BALF and EBC could facilitate the diagnosis of VAP, which may guide the administration of antibiotics when VAP is suspected.