髓系细胞触发受体-1、降钙素原分别联合临床肺部感染评分对呼吸机相关性肺炎的诊断价值

Diagnostic value of myeloid cell trigger receptor-1 and procalcitonin combined with clinical pulmonary infection score in ventilator-associated pneumonia

目的探讨TREM-1、PCT分别联合CPIS在VAP中的诊断价值。方法选取2020年1月5月我院ICU收治的气管插管或气管切开接受有创机械通气治疗的住院患者156例,根据病情分为VAP组(66例)和非VAP组(90例),比较两组患者在机械通气后第1 d、3 d、7 d的血清TREM-1、PCT及CPIS间的差异。绘制ROC曲线评估血清TREM-1、PCT分别联合CPIS诊断VAP的应用价值。结果对两组患者TREM-1、PCT、CPIS进行重复测量方差分析显示:①TREM-1的时间效应、处理效应和交互效应均有统计学意义(F_(时间)=135.684,P<0.001;F_(处理)=577.117,P<0.001;F_(交互)=62.408,P<0.001);②PCT的时间效应、处理效应和交互效应均有统计学意义(F_(时间)=35.129,P<0.001;F_(处理)=158.284,P<0.001;F_(交互)=31.220,P<0.001);③CPIS的时间效应、处理效应和交互效应均有统计学意义(F_(时间)=14.445,P<0.001;F_(处理)=148.629,P<0.001;F_(交互)=4.968,P=0.008)。血清TREM-1、PCT和CPIS诊断VAP的AUC分别为0.977、0.907和0.922。而TREM-1+CPIS评分和PCT+CPIS评分联合诊断VAP的AUC分别为0.976和0.944,均明显高于3项指标的单独应用。结论TREM-1尤其是TREM-1+CPIS评分对机械通气患者早期诊断VAP具有优势,TREM-1+CPIS评分对评估VAP具有更高的诊断效能。

Objective To explore the diagnostic value of triggering receptor expressed on myoid cells-1(TREM-1),procalcitonin(PCT)and clinical pulmonary infection score(CPIS)in ventilator associated pneumonia(VAP).Methods 156 inpatients in ICU of our hospital from January to May 2020 were divided into the VAP group(66 cases)and the non VAP group(90 cases).The differences of serum TREM-1,PCT and CPIS between the two groups were compared on the first day,the third day and the seventh day after mechanical ventilation.It drew ROC curve to evaluate the application value of serum TREM-1 and PCT combined with CPIS to diagnose VAP.Results Their TREM-1,PCT and CPIS were measured by repeated measurement ANOVA.The results showed that:①the time effect,treatment effect and interaction effect of TREM-1 were statistically significant(F_(time)=135.684,P<0.001;F_(treatment)=577.117,P<0.001;F_(interaction)=62.408,P<0.001).②The time effect,processing effect and interaction effect of PCT level were statistically significant(F_(time)=35.129,P<0.001;F_(treatment)=158.284,P<0.001;F_(interaction)=31.220,P<0.001);③CPIS score time effect,processing effect and interaction effect should be statistically significant(F_(time)=14.445,P<0.001;F_(treatment)=148.629,P<0.001;F_(interaction)=4.968,P=0.008).The AUC of serum TREM-1,PCT and CPIS in the diagnosis of VAP were 0.977,0.907 and 0.922,respectively.The AUC of TREM-1+CPIs and PCT+CPIs were 0.976 and 0.944,respectively,which were significantly higher than the application of the three indicators alone.Conclusion TREM-1,especially TREM-1+CPIs,has an advantage in the early diagnosis of VAP in patients with mechanical ventilation.TREM-1+CPIs has a higher diagnostic efficiency in the evaluation of VAP.