可溶性髓样细胞触发受体1和降钙素原联合检测在重症社区获得性肺炎中的应用价值

Combined measurement of soluble triggering receptor expressed on myeloid cells-1 and procalcitonin in the diagnosis of severe community-acquired pneumonia

目的探讨血清可溶性髓样细胞触发受体1(s TREM-1)和降钙素原(PCT)对重症社区获得性肺炎(SCAP)诊断和预后评估的意义。方法选取2012年1月至2015年2月海南省人民医院呼吸内科收治的67例社区获得性肺炎(CAP)患者(重症肺炎组46例,普通肺炎组21例),采用酶联免疫测定法测定入院第1、3、7、14天血清s TREM-1和PCT浓度。根据28 d转归将46例重症肺炎患者分为非死亡组(35例)和死亡组(11例),分析s TREM-1和PCT水平及动态变化与病情严重程度、发展及预后的相关性。结果重症肺炎组患者第1天血清s TREM-1和PCT水平[(96.48±13.99)pg/m L、(3.19±0.38)ng/m L]均明显高于普通肺炎组[(67.48±8.89)pg/m L、(2.11±0.46)ng/m L],差异均有统计学意义(P<0.05)。s TREM-1和PCT对重症肺炎组诊断的曲线下面积(AUC)为0.963、0.967,联合两者诊断SCAP的ROC曲线下面积为0.983。第1、3、7、14天非死亡组患者的血清s TREM-1和PCT水平随时间推移逐渐下降,而死亡组显著上升,且死亡组第14天的s TREM-1[(167.88±31.65)pg/m L]和PCT[(8.62±1.58)ng/m L]水平均显著高于非死亡组[(69.14±23.53)pg/m、(0.68±0.57)ng/m L],差异均有统计学意义(P<0.05)。Logistic回归分析显示,血清s TREM-1和PCT水平可作为重症社区获得性肺炎预后的危险因素(P<0.05)。结论联合检测血清s TREM-1和PCT有助于早期诊断重症社区获得性肺炎,动态监测s TREM-1水平变化对疗效的评价、指导抗生素的使用和患者预后的判断具有重要的临床意义。

Objective To determine the usefulness of soluble triggering receptor expressed on myeloid cells-1（s TREM-1） and procalcitonin（PCT） in severe community-acquired pneumonia（SCAP）. Methods This is a prospective longitudinal cohort study. Serum PCT and s TERM-1 concentrations were measured in 67 patients suffering from community-acquired pneumonia（between January 2012 and February 2015, Department of Respiratory Medicine, Hainan General Hospital）. The subjects were divided into two groups： the mild CAP group（21 patients） and the severe CAP group（46 patients）. Serum s TREM-1 and PCT levels were determined by ELISA at four time points： on day 1, day 3,day 7 and day 14. Furthermore, according to the 28 days outcome, patients in severe CAP group were divided into the good outcome subgroup（35 patients） and the dead subgroup（11 patients）. The relationship between s TREM-1 PCT and severity outcome were analyzed. Results The serum s TREM-1 and PCT were（96.48 ± 13.99） pg/m L,（3.19 ±0.38） ng/m L in severe CAP group, as compared with（69.14±23.53） pg/m L,（0.68±0.57） ng/m L in mild CAP group（P〈0.01）. The area under the ROC curve（AUC） was 0.963 for s TREM-1, 0.967 for PCT, and 0.983 for combined method based on s TREM-1 and PCT. During a 14-day observation period, the serum s TREM-1 and PCT levels presented a downward trend in the good outcome group, but an upward trend in the death group. The TREM-1 and PCT levels on day 14 were（167.88±31.65） pg/m L,（8.62±1.58） ng/m L in death group, as compared with（69.14±23.53） pg/m L,（0.68±0.57） ng/m L in good outcome group（P〈0.05）. Logistic regression analysis showed that serum s TREM-1 and PCT levels were important markers of mortality in patients suffering from CAP. Conclusion The combined measurement of serum s TREM-1 and procalcitonin concentrations could be of interest in detecting the presence of CAP and in discriminating mild and severe CAP.