尿源性感染导致脓毒血症患者血清sTREM-1的检测评价

Value of serum sTREM-1 in diagnosis of patients with sepsis induced by urinary infection

目的探讨血清髓样细胞触发受体1(sTREM-1)对尿源性脓毒血症患者的检测价值。方法选取2013年1月-2016年1月医院泌尿外科收治的114例腔镜手术后尿源性脓毒血症患者为研究组,另选同期医院行腔镜手术未发生尿源性脓毒血症患者100例为对照组;入院24h后、术后1h、术后1、3、7d检测sTREM-1、降钙素原(PCT)、C-反应蛋白(CRP)、白介素6(IL-6)水平;同时根据患者入院24h内各项指标的最差值进行急性生理及慢性健康评分标准Ⅱ(APACHEⅡ)评分,记录两组患者30d内存活情况。结果入院24h后、术后1h、术后1、3、7d研究组sTREM-1均显著高于对照组(P<0.05);与PCT、CRP和IL-6相比,sTREM-1诊断尿脓毒血症的敏感性、特异性、阳性预测值和阴性预测值均较高;Spearman相关性分析结果显示,sTREM-1(r=0.859,P<0.01)、PCT(r=0.732,P<0.01)、CRP(r=0.502,P=0.025)和IL-6(r=0.431,P=0.032)与APACHEⅡ均存在明显正相关性;114例尿源性脓毒血症患者30d内死亡31例,病死率为27.19%;死亡组sTREM-1、PCT、CRP和IL-6峰值浓度均显著高于存活组(P<0.05);sTREM-1浓度与尿源性脓毒血症死亡患者生存时间的相关性分析结果显示,sTREM-1峰值浓度(r=-0.651,P<0.01)与预后呈负相关。结论 sTREM-1在尿源性脓毒血症早期诊断、病情评估和预后判断中具有指导意义。

OBJECTIVE To explore the value of serum triggering receptor expressed on myeloid cells-1 （sTREM-1） in diagnosis of patients with urinary sepsis.METHODS Totally 114 patients with postoperative urinary sepsis who underwent endoscopic surgery in urology department from Jan 2013 to Jan 2016 were chosen as the study group, meanwhile, 100 patients who underwent endoscopic surgery during the same period but did not have urinary sepsis were set as the control group.The levels of sTREM-1, procalcitonin （PCT）, C-reactive protein （CRP）, and interleukin-6 （IL-6） were detected after the admission for 24 hours and after the surgery for 1 hour, 1, 3, and 7 days;the Acute Physiology and Chronic Health Evaluation II （APACHE II） scoring was performed based on the worst value of the indicators within 24 hours after the admission, and the 30-day survival rates of the two groups were recorded.RESULTS The sTREM-1 level of the study group was significantly higher than that of the control group after the admission for 24 hours and after the surgery for 1 hour, 1, 3, and 7 days （P〈0.05）.The sensitivity, specificity, positive predictive value, and negative predictive value of the sTREM-1 were higher in diagnosis of urinary sepsis than the PCT, CRP, and IL-6.The result of Spearman correlation analysis showed that the APACHEⅡ was positively correlated with the sTREM-1（r=0.859,P〈0.01）, PCT（r=0.732,P〈0.01）, CRP（r=0.502,P=0.025） and IL-6（r=0.431,P=0.032）.Of the 114 patients with urinary sepsis, 31 died within 30 days, with the mortality rate 27.19%.The peak concentrations of sTREM-1, PCT, CRP, and IL-6 of the death group were significantly higher than those of the survival group （P〈0.05）.The analysis of the correlation between the sTREM-1 concentration and the survival time of the urinary sepsis patients who died showed that the peak concentration of sTREM-1 （r=-0.651,P〈0.01） was negatively correlated with prognosis.CONCLUSION The STREM-1 had guiding significance in early diagnosis, condition assessment, and prediction of prognosis of the urinary sepsis.