血清sTREM-1和CRP/Alb比值监测在糖尿病酮症酸中毒合并感染中的应用价值

Application value of serum sTREM-1 and CRP/Alb value monitoring in diabetic ketoacidosis complicated with infection

目的探究糖尿病酮症酸中毒合并感染(DKA感染)患者血清中可溶性髓系细胞触发受体1(sTREM-1)、C-反应蛋白(CRP)/白蛋白(Alb)水平的变化,并初步探究两者在DKA感染中的诊断价值。方法选取97例DKA患者,根据是否发生感染分为DKA感染组(46例)、DKA无感染组(51例),采用酶联免疫法检测血清中sTREM-1水平,免疫比浊法检测CRP水平,溴甲酚绿法检测Alb水平。监测两组入院3 d内血清sTREM-1和CRP/Alb水平变化情况,logistic回归分析DKA感染的危险因素,采用受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)评估血清中入院3 d内血清sTREM-1和CRP/Alb水平在DKA患者感染中的诊断价值。结果与DKA无感染组相比,DKA感染组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿淀粉酶、血淀粉酶、血肌酐(Scr)、乳酸水平、血清sTREM-1和CRP/Alb比值均显著升高(P<0.05)。与DKA无感染组相比,DKA感染组在入院后1~3 d血清sTREM-1、CRP/Alb均显著升高,入院后2、3 d血清sTREM-1、CRP/Alb变化程度显著降低(P<0.05)。ALT、血淀粉酶、sTREM-1d3、sTREM-1Δd3、CRP/Albd3、CRP/AlbΔd3均为影响DKA感染的独立危险因素。sTREM-1d3诊断DKA感染的AUC为0.832,sTREM-1Δd3的AUC为0.857,CRP/Albd3的AUC为0.814,CRP/AlbΔd3的AUC为0.836。结论DKA感染患者血清中sTREM-1、CRP/Alb水平均升高,入院3 d两者水平及变化程度的监测对DKA感染具有较高的诊断价值。

Objective To investigate the changes of serum soluble myeloid triggering receptor 1(sTREM-1),C-reactive protein(CRP)/albumin(Alb)levels in patients with diabetic ketoacidosis complicated with infection(DKA infection),and to explore the diagnostic value of both in DKA infection.Methods 97 patients with DKA who were treated in our hospital were selected and divided into DKA infected group(46 cases)and DKA non-infected group(51 cases),serum sTREM-1 level was detected by ELISA,the level of CRP was detected by immunoturbidimetry,and Alb level was detected by bromocresol green method.Levels of serum sTREM-1 and CRP/Alb were monitored within 3 d after admission,logistic regression analysis was used to analyze the risk factors of DKA infection,and the diagnostic value of serum sTREM-1 and CRP/Alb levels in patients with DKA infection within 3 d of admission was evaluated by ROC curve and area under curve(AUC).Results Compared with DKA non-infected group,alanine aminotransferase(ALT),aspartate aminotransferase(AST),urinary amylase,blood amylase,serum creatinine(Scr),lactate level,serum sTREM-1 and CRP/Alb value were significantly increased in DKA infected group(P<0.05).Compared with DKA non-infected group,serum sTREM-1,CRP/Alb in DKA infected group increased significantly at d1,d2 and d3 after admission,the changes of serum sTREM-1 and CRP/Alb at d1 and d2 were significantly decreased(P<0.05).ALT,blood amylase,sTREM-1d3,sTREM-1Δd3,CRP/Albd3 and CRP/AlbΔd3 were all independent risk factors for DKA infection.The AUC of sTREM-1d3 in diagnosing DKA infection was 0.832,the AUC of sTREM-1Δd3 was 0.857,the AUC of CRP/Albd3 was 0.814,and the AUC of CRP/AlbΔd3 was 0.836.Conclusion The levels of serum sTREM-1 and CRP/Alb in patients with DKA infection are increased,the monitoring of the levels and changes of sTREM-1 and CRP/Alb in patients with DKA infection on the 3rd day after admission has high diagnostic value.