腹部创伤脓毒症患者腹腔引流液可溶性髓样细胞触发受体-1水平变化的临床意义

Clinical significance of soluble myeloid cell trigger receptor-1 level in peritoneal drainage fluid of patients with abdominal trauma sepsis

目的观察腹部创伤脓毒症患者腹腔引流液中可溶性髓样细胞触发受体-1(sTREM-1)水平变化,探讨腹腔引流液sTREM-1在腹创伤脓毒症诊断和预后中的意义。方法选取2013年10月—2017年10月海南省人民医院重症医学科住院的腹部创伤脓毒症患者50例作为观察组,选取同期住院治疗的胃大部分切除术非脓毒症患者50例作为对照组。采用ELISA方法检测患者入组当天腹腔引流液sTREM-1水平,观察腹部创伤脓毒症患者中存活亚组和死亡亚组入组第1、4、7 d以及出院或死亡当天腹腔引流液sTREM-l水平变化趋势。结果腹部创伤脓毒症患者入组后第1 d腹腔引流液sTREM-1水平高于对照组(t/P=4.006/0.000)。腹创伤脓毒症存活亚组患者腹腔引流液sTREM-1水平治疗后呈下降趋势,而死亡亚组患者腹腔引流液sTREM-1水平保持较高水平甚至不断升高,各相同时间点sTREM-1水平均显著高于存活亚组(t/P=2.150/0.037、4.417/0.000、6.991/0.000、11.186/0.000)。腹腔引流液sTREM-1与血浆sTREM-1水平呈正相关(r=0.585,P=0.001)。腹腔引流液sTREM-1诊断腹部创伤脓毒症的曲线下面积为0.937,高于血浆sTREM-1、C反应蛋白(CRP)及降钙素原(PCT)。结论腹腔引流液sTREM-1水平对腹部创伤脓毒症的诊断具有参考价值,可能与腹部创伤脓毒症严重程度相关。动态监测腹腔引流液sTREM-1水平变化,有利于评估腹部创伤脓毒症的治疗效果和判断预后。

Objective To observe the changes of soluble myeloid cell triggering receptor-1(sTREM-1)in abdominal drainage fluid of abdominal traumatic sepsis patients,and to explore the significance of sTREM-1 in the diagnosis and prognosis of abdominal traumatic sepsis.Methods From October 2013 to October 2017,50 patients with abdominal trauma and sepsis were selected as observation group and 50 patients with non-sepsis after gastrectomy were selected as control group.The levels of sTREM-1 in abdominal drainage fluid were measured by ELISA on the day of admission.The changes of sTREM-l levels in survival and death subgroups on the 1st,4th and 7th day of admission and on the day of discharge or death were observed.Results The level of sTREM-1 in the abdominal drainage fluid on the 1st day after abdominal traumatic sepsis was higher than that in the control group(t/P=4.006/0.000).In the subgroup of patients with abdominal trauma and sepsis,the level of sTREM-1 in the peritoneal drainage fluid showed a downward trend after treatment,while the level of sTREM-1 in the peritoneal drainage fluid of the death subgroup remained high or even increased,and the indicators at the same time point were significantly higher.Higher than the survival subgroup(t/P=2.150/0.037,t/P=4.417/0.000,t/P=6.991/0.000,t/P=11.186/0.000).The abdominal drainage fluid sTREM-1 was positively correlated with plasma sTREM-1 level(r=0.585,P=0.001).The area under the curve of abdominal drainage sTREM-1 for the diagnosis of abdominal trauma sepsis was 0.937,which was higher than plasma sTREM-1,C-reactive protein(CRP)and procalcitonin(PCT).Conclusion The level of sTREM-1 in the abdominal drainage fluid has a reference value for the diagnosis of abdominal trauma sepsis and may be related to the severity of abdominal trauma sepsis.Dynamic monitoring of changes in the level of sTREM-1 in the abdominal drainage fluid is beneficial to evaluate the therapeutic effect and prognosis of abdominal traumatic sepsis.