获得性肺部感染老年患者肺泡灌洗液和血清中sTREM-1、HMGB1的表达及临床意义

Expressions and clinical significance of sTREM-1 and HMGB1 in alveolar lavage fluid and serum of elderly patients with acquired lung infection

目的探讨可溶性髓样细胞触发受体-1(sTREM-1)和高迁移率族蛋白B1(HMGB1)在获得性肺部感染老年患者肺泡灌洗液及血清中的表达及临床意义。方法选取103例获得性肺部感染老年患者作为观察组,同期体检无肺部感染的60例老年志愿者作为对照组,收集2组受检者的临床资料,比较2组受检者入院第1天或者体检当日的肺泡灌洗液及血清中sTREM-1、HMGB1水平,采用受试者工作(ROC)曲线下面积(AUC)评价肺泡灌洗液及血清中sTREM-1、HMGB1水平对获得性肺部感染的诊断价值;将观察组患者分为轻症组和重症组2个亚组,比较2个亚组肺泡灌洗液及血清中sTREM-1、HMGB1水平,采用Spearman法分析获得性肺部感染老年患者肺泡灌洗液及血清中sTREM-1、HMGB1水平与肺部感染严重程度的关系。结果2组受试者年龄、性别、凝血酶时间(TT)比较,差异无统计学意义(P>0.05);观察组患者白细胞介素-10(IL-10)、降钙素原(PCT)、C-反应蛋白(CRP)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、白细胞(WBC)及血小板(PLT)水平均高于对照组(P<0.05),肺泡灌洗液及血清中sTREM-1、HMGB1水平高于对照组(P<0.001);ROC曲线显示,单独检测肺泡灌洗液或血清中sTREM-1、HMGB1水平均可作为诊断获得性肺部感染的效能指标(P<0.05);重症亚组肺泡灌洗液及血清中sTREM-1、HMGB1水平高于轻症亚组(P<0.05);Spearman相关分析发现,获得性肺部感染患者肺泡灌洗液及血清中sTREM-1、HMGB1水平与肺部感染严重程度具有正相关(P<0.05)。结论sTREM-1、HMGB1可能参与获得性肺部感染发病及进展过程,检测肺泡灌洗液或血清中2项指标,有助于早期诊断疾病及评估病情的严重程度。

Objective To investigate the expression and clinical significance of soluble myeloid cell trigger receptor-1(sTREM-1)and high mobility group protein B1(HMGB1)in alveolar lavage fluid and serum of elderly patients with acquired lung infection.Methods A total of 103 elderly patients with acquired pulmonary infection were selected as observation group,and 60 elderly volunteers who had no lung infection during physical examination were selected as control group.The clinical information of the subjects in two groups was collected.The level of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum on the first hospital admission or the day of the physical examination were compared between the two groups.The area under curve(AUC)of the receiver operating(ROC)was used to evaluate the diagnostic precision of the level of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum in diagnosing pulmonary infection.Observation group was divided into mild and severe subgroups.The levels of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum of the two subgroups were compared.Spearman correlation analysis was used to evaluate the association of the levels of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum with the severity of lung infection of elderly patients with acquired lungs.Results There was no significant differences in age,gender and thrombin time(TT)between two groups(P>0.05).Observation group had higher levels of interleukin-10(IL-10),procalcitonin(PCT),C-reactive protein(CRP),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),white blood cells(WBC)and platelets(PLT)than those of control group(P<0.05).The levels of sTREM-1 and HMGB1 in alveolar lavage fluid and serum were higher than those in control group(P<0.05).ROC curve showed that the levels of sTREM-1 alone or HMGB1 alone in alveolar lavage fluid or serum can be used as efficacy indicators for diagnosing acquired lung infection(P<0.05).The levels of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum were higher in severe subgroup than those in mild subgroup(P<0.05).Spearman correlation analysis demonstrated that the levels of sTREM-1 and HMGB1 in the alveolar lavage fluid and serum were positively correlated with the severity of lung infection(P<0.05).Conclusion sTREM-1 and HMGB1 may be involved in the pathogenesis and progression of acquired lung infection.The detection of these two indicators in alveolar lavage fluid or serum is helpful for early diagnosis of the disease and assessment of the severity of the disease.