外周血可溶性髓系细胞触发受体-1与可溶性血红蛋白清道夫受体对烧伤患者脓毒症的诊断价值研究

Values of peripheral blood soluble triggering receptor expressed on myeloid cells-1 and soluble hemoglobin scavenger receptor in diagnosis of sepsis in burn patients

目的探讨外周血可溶性髓系细胞触发受体-1(sTREM-1)与可溶性血红蛋白清道夫受体(sCD163)等指标对烧伤患者脓毒症诊断的临床价值。方法选取2014年8月-2016年8月烧伤住院患者82例,分为脓毒症组18例、局部感染组31例和未感染组33例;采用酶联免疫吸附法(ELISA)检测sTREM-1和sCD163,并临床常规检测降钙素原(PCT)和C-反应蛋白(CRP);应用ROC曲线分析sTREM-1和sCD163的临床诊断价值。结果入组第1天各组患者血清sTREM-1、sCD163、PCT和CRP水平,差异有统计学意义(P<0.01);脓毒症组患者血清sTREM-1、sCD163、PCT水平高于局部感染组和未感染组患者(P<0.01),局部感染组患者血清sTREM-1、sCD163、PCT和CRP水平高于未感染组患者(P<0.01);入组第7天,各组血清sTREM-1、sCD163、PCT、CRP水平均低于同组第1天水平(P<0.05);血清sTREM-1和sCD163水平呈正相关(r=0.652,P<0.01);血清sTREM-1、sCD163联合检测诊断脓毒症,其AUC为0.916(95%CI:0.856~0.976);血清PCT、CRP联合检测诊断脓毒症,其AUC为0.842(95%CI:0.744~0.940)。结论烧伤患者随着感染程度的加重,血清sTREM-1和sCD163水平升高,此两种指标有助于烧伤患者脓毒症的诊断。

OBJECTIVE To explore the clinical value of peripheral blood soluble triggering receptor expressed on myeloid cells-1（sTREM-1）and soluble hemoglobin scavenger receptor（sCD163）in diagnosis of sepsis in burn patients.METHODS A total of 82 burn patients who were hospitalized from Aug 2014 to Aug 2016 were enrolled in the study and divided into the sepsis group with 18 cases,the local infection group with 31 cases and the non-infection group with 33 cases.The sTREM-1 and sCD163 were detected by using enzyme-linked immunosorbent assay（ELISA）,the clinical routine examination of procalcitonin（PCT）and C-reactive protein（CRP）was carried out,and the clinical diagnostic values of the sTREM-1 and sCD163 were analyzed by using ROC curve.RESULTS There were significant differences in the levels of serum sTREM-1,sCD163,PCT and CRP among the three groups on Day 1 of enrollment（P〈0.01）.The levels of serums TREM-1,sCD163 and PCT of the sepsis group were significantly higher than those of the local infection group and the non-infection group（P〈0.01）,the levels of serums TREM-1,sCD163,PCT and CRP of the local infection group were significantly higher than those of the noninfection group（P〈0.01）.The levels of sTREM-1,sCD163,PCT and CRP of the three groups were significantly lower on Day 7 of enrollment than on Day 1 of enrollment（P〈0.05）.The serum sTREM-1 was significantly positively correlated with the sCD163 level（r=0.652,P〈0.01）.The AUC of the serum sTREM-1 combined with sCD163 in diagnosis of sepsis was 0.916（95%CI：0.856~0.976）;the AUC of the serum PCT combined with CRP in diagnosis of sepsis was 0.842（95%CI：0.744~0.940）.CONCLUSION The levels of serum sTREM-1 and sCD163 of the burn patients are elevated with the increase of degree of infection,and the two types of indexes may facilitate the diagnosis of sepsis in the burn patients.