急性呼吸窘迫综合征病人血清可溶性髓样细胞触发受体1、巨噬细胞炎症蛋白-1α的表达

Expression of soluble myeloid cell triggering receptor 1 and macrophage inflammatory protein-1αin serum of patients with acute respiratory distress syndrome

目的研究血清可溶性髓样细胞触发受体1(sTREM-1)、巨噬细胞炎症蛋白-1α(MIP-1α)对多发伤所致急性呼吸窘迫综合征(ARDS)合并肺部感染的预测价值。方法选取2016年3月至2019年5月枣庄矿业集团中心医院收治的多发伤ARDS病人156例,根据有无合并肺部感染分为非感染组(85例)和感染组(71例)。采集受试者住院后4 h外周静脉血并分离血清,采用酶联免疫吸附试验(ELISA)检测受试者血清sTREM-1、MIP-1α水平,采用Pearson法分析血清sTREM-1、MIP-1α水平与多发伤ARDS发生肺部感染病人创伤严重程度(ISS)评分及急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性,采用logistic回归分析影响多发伤ARDS病人发生肺部感染的危险因素,采用ROC分析血清sTREM-1、MIP-1α水平对多发伤ARDS病人发生肺部感染的预测价值。结果与非感染组比较,肺部感染组ISS评分[(27.81±5.32)分比(21.65±4.93)分]、APECHEⅡ评分[(25.43±5.08)分比(18.16±3.74)分]、气管插管时间[(123.04±18.61)h比(86.53±15.31)h]、28 d死亡人数比例[(17.65%)比(39.44%)]、ICU住院时间[(14.84±2.16)d比(9.67±2.34)d]、白细胞计数[(17.81±5.34)×10^(9)/L比(14.27±3.63)×10^(9)/L]、降钙素原(PCT)[(10.87±2.19)ng/L比(6.96±1.22)ng/L]、C-反应蛋白(CRP)[(83.12±14.51)mg/L比(66.53±12.71)mg/L]、sTREM-1[(5.68±1.23)ng/mL比(3.45±0.74)ng/mL]、MIP-1α水平[(97.58±13.37)pg/mL比(89.46±11.21)pg/mL]显著升高(P<0.05),氧合指数(PaO2/FiO2)[(136.94±17.87)mm Hg比(181.72±20.15)mm Hg]水平显著降低(P<0.05)。血清sTREM-1、MIP-1α水平、ISS评分、APACHEⅡ评分高均是影响多发伤ADRS病人发生肺部感染的危险因素(均P<0.05)。肺部感染组多发伤ARDS病人血清sTREM-1、MIP-1α水平成正相关,分别与ISS评分、APACHEⅡ评分均呈正相关(均P<0.05)。血清PCT、CRP、sTREM-1、MIP-1α预测多发伤ARDS合并肺部感染发生的曲线面积(AUC)分别为0.945、0.865、0.883、0.721,灵敏度分别为85.90%、90.10%、81.70%、62.00%,特异度分别为97.60%、68.20%、88.20%、78.80%。血清sTREM-1、MIP-1α水平联合检测AUC为0.915,灵敏度为88.70%,特异度度为89.40%。血清PCT、CRP、sTREM-1、MIP-1α的联合应用对多发伤ARDS的预测价值分析AUC为0.991,灵敏度和特异度分别为97.20%和98.80%。结论多发伤ARDS合并肺部感染病人血清sTREM-1、MIP-1α高表达,且与病人疾病严重程度有关,两者联合检测对多发伤ARDS合并肺部感染发生有一定预测价值。

Objective To study the predictive value of serum soluble myeloid trigger receptor 1(sTREM-1)and macrophage inflammatory protein-1α(MIP-1α)in acute respiratory distress syndrome(ARDS)complicated with pulmonary infection caused by multiple trauma.Methods A total of 156 patients with multiple traumatic ARDS admitted to intensive care unit(ICU)of Central Hospital of Zaozhuang Mining Group from March 2016 to May 2019 were divided into non-infectious group(85 cases)and infectious group(71 cases)according to the presence or absence of pulmonary infection.Peripheral venous blood was collected and serum was separated at 4 h after hospitalization,the levels of serum sTREM-1 and MIP-1αwere measured by enzyme-linked immunosorbent assay(ELISA),Pearson method was used to analyze the correlations between serum sTREM-1 and MIP-1αlevels and the injury severity scale(ISS)score,acute physiology and chronic health score II(APACHE II)score of patients with multiple traumatic ARDS with pulmonary infection,Logistic regression analysis was used to analyze the risk factors of pulmonary infection in patients with multiple traumatic ARDS,and the predictive values of serum sTREM-1 and MIP-1αlevels for pulmonary infection in multiple traumatic ARDS patients were analyzed by ROC.Results Compared with non-infection group,the ISS score[(27.81±5.32)score vs.(21.65±4.93)score],APECHE II score[(25.43±5.08)score vs.(18.16±3.74)score],endotracheal intubation time[(123.04±18.61)h vs.(86.53±15.31)h],28 d mortality rate[(17.65%)vs.(39.44%)],ICU hospitalization time[(14.84±2.16)d vs.(9.67±2.34)d],leukocyte count[(17.81±5.34)×10^(9)/L vs.(14.27±3.63)×10^(9)/L],serum procalcitonin(PCT)[(10.87±2.19)ng/L vs.(6.96±1.22)ng/L],C-reactive protein(CRP)[(83.12±14.51)mg/L vs.(66.53±12.71)mg/L],sTREM-1[(5.68±1.23)ng/mL vs.(3.45±0.74)ng/mL]and MIP-1αlevels[(97.58±13.37)pg/mL vs.(89.46±11.21)pg/mL]in ARDS patients with pulmonary infection were high(P<0.05),the Oxygenation index(PaO2/FiO2)[(136.94±17.87)mm Hgvs.(181.72±20.15)mm Hg]was low.High serum sTREM-1,MIP-1αlevel,ISS score and APACHE II score were all risk factors for pulmonary infection in ADRS patients with multiple trauma(P<0.05).Serum sTREM-1 and MIP-1αlevels were positively correlated inpatients with multiple traumatic ARDS in pulmonary infection group,and positively correlated with ISS score and APACHE II score(P<0.05).The areas under curve(AUC)of serum PCT,CRP,sTREM-1 and MIP-1αpredicting the occurrence of multiple traumaticARDS with pulmonary infection were 0.945,0.865,0.883,0.721,respectively,the sensitivity were 85.90%、90.10%,81.70%,62.00%,respectively.The specificity were 97.60%,68.20%,88.20%,78.80%,respectively.The combined detection of serum sTREM-1 and MIP-1αlevels AUC was 0.915,the sensitivity was 88.70%,and the specificity was 89.40%.The combined detection of serumPCT,CRP,sTREM-1 and MIP-1αlevels AUC was 0.991,the sensitivity was 97.20%,and the specificity was 98.80%.Conclusion s Serum sTREM-1 and MIP-1αare highly expressed in patients with multiple traumatic ARDS complicated with pulmonary infection,and they are related to the severity of the disease.The combined detection of the two has certain predictive value for the occurrence ofmultiple traumatic ARDS complicated with pulmonary infection.