严重胸部创伤后髓系细胞触发受体-1的表达变化及临床意义

Expression changes and their clinical significance of triggering receptors of myeloid cells-1 after severe thoracic trauma

目的探讨严重胸部创伤患者髓系细胞触发受体-1（TREM-1）表达的变化及其在临床中的应用价值。方法采用前瞻性队列研究分析2016年10月-2017年5月收治的52例严重胸部创伤患者（创伤组）的临床资料。伤后1，3，5，7，14d采集外周抗凝血。同时纳入lO例健康志愿者作为对照组，采血1次。根据损伤严重度评分（ISS），将胸部创伤患者分为ISS低分组（〈20分，15例）和ISS高分组（≥20分，37例）。根据美国重症医学会（SCCM）／欧洲危重病医学会（ESICM）最新发布的脓毒症3．0的定义和标准，将胸部创伤患者分为创伤非脓毒症组（34例）和创伤脓毒症组（18例）。采用流式细胞术检测中性粒细胞和单核细胞TREM-1的表达，比较创伤组与对照组、1SS高分组与低分组、创伤脓毒症组与非脓毒症组之间的差异，并进一步应用受试者工作特征（ROC）曲线下面积（AUC）评价TREM-1对创伤脓毒症的预警价值。结果创伤组男41例，女11例；年龄（45．9±12．4）岁。胸部简明损伤定级（AIS）（3．5±0．6）分，ISS（23．6±8．5）分。对照组男8例，女2例；年龄（29．1±2．8）岁。与对照组比较，伤后各时相点创伤组中性粒细胞TREM-1表达水平略低，而单核细胞TREM-l表达水平显著升高（P均〈0．01）。与ISS低分组比较，ISS高分组中性粒细胞TREM一1在1—7d表达水平略低，其中1d差异有统计学意义（P〈0．05），而单核细胞TREM-1在伤后各时相点表达水平均略高，其中14d差异有统计学意义（P〈0．05）。与创伤非脓毒症组比较，创伤脓毒症组中性粒细胞TREM-1在伤后各时相点表达水平均显著降低（P均〈0．05），而单核细TREM-1在伤后1～7d表达水平略低，其中3d差异有统计学意义（P〈0．05）。在伤后1，3，5，7，14d，中性粒细胞TREM-1表达水平对脓毒症预警诊断的AUC和95％凹分别为0．852（0．738，0．966），0．835（0．721，0．948），0．797（0．654，0．939），0．756（0．599，0．914）和0．707（0．525，0．888）。结论严重胸部创伤后TREM-1在中性粒细胞中表达减少，在单核细胞中表达增多。TREM-l可用来评估创伤严重程度．并且对创伤脓毒症的早期预警诊断有一定的价值。

Objective To investigate the expression change and their clinical role of triggering receptor expressed on myeloid cells-1 （TREM-I） in patients with severe thoracic trauma. Methods A prospective cohort study was conducted to analyze the clinical data of 52 patients with severe thoracic trauma （trauma group） hospitalized from October 2016 to May 2017. The peripheral anticoagulant blood samples were collected at days 1, 3, 5, 7 and 14 after trauma. Meanwhile, 10 healthy volunteers were enrolled in control group and their blood samples were collected once. According to injury severity score （ISS）, the patients were divided into ISS low-score group （ 〈 20 points, n = 15 ） and high-score group （ 〉~20 points, n = 37）. The patients were assigned to traumatic non-sepsis group （n = 34） and traumatic sepsis group （n = 18） by the latest definition and standard of sepsis 3.0 issued by the Society of Critical Care Medicine （SCCM）/European Society of Intensive Care Medicine （ESICM）. The expressions of TREM-1 on neutrophils and monocytes were measured by flow cytometry. Pairwise comparisons were done between trauma group and healthy volunteers, ISS low-score group and ISS high-score group, and traumatic sepsis group and non-sepsis group, respectively. The accuracy of traumatic sepsis prediagnosis by TREM-1 was evaluated by the area under receiver operating characteristic curve （AUC）. Results Trauma group had 41 males and 11 females, with age of （45.9 ± 12.4） years, Abbreviated Injury Scale （AIS） of （3.5±0.6）points and Injury Severity Score （ISS） of （23.6 ± 8.5）points. Control group had eight males and two females, with the age of（29.1 ± 2.8 ） years. Compared to control group, trauma group had slightly lower TREM-1 expressions in neutrophils and significantly higher expressions in monocytes at days 1 to 14 （ all P 〈 0.01 ）. ISS high-score group had slightly lower TREM- 1 expressions in neutrophils than ISS low-score group at days 1 to 7, with significant difference at day 1 （P 〈 0.05）. ISS high-score group had slightly higher TREM-1 expressions in monocytes than ISS low- score group at days 1 to 14, with significant difference at day 14 （P 〈 0.05）. Compared to traumatic non-sepsis group, traumatic sepsis group had significantly lower TREM-1 expressions in nentrophils at days 1 to 14 （ all P 〈 0.05）. Traumatic sepsis group had slightly lower expressions in monocytes than traumatic non-sepsis group at days 1 to 7, with significant difference at day 3 （ P 〈 0.05）. AUC and 95% CI evaluating the role of neutrophils TREM-1 in traumatic sepsis prediagnosis were 0. 852 （0.738, 0.966） at day 1, 0. 835 （0. 721, 0. 948） at day 3, 0.797 （0.654, O. 939） at day 5, 0. 756 （0.599, 0. 914） at day 7, and 0. 707 （0. 525, 0. 888 ） at day 14, respectively. Conclusions After severe thoracic trauma, the expressions of TREM-1 are decreased in neutrophils but increased in monocytes. TREM- 1 might be used to assess the injury severity and has certain value in prediagnosis for traumatic sepsis.