摘要
目的探讨血清可溶性髓系细胞触发受体(soluble triggering receptor expressed on myeloid-1,sTREM-1)、降钙素原(procalcitonin,PCT)和人软骨糖蛋白39(human cartilage glycoprotein-39,YKL-40)对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者的表达意义、VAP预后的预测价值及VAP发生的危险因素。方法选取2018年1月~2020年6月在河北省邢台市第三医院ICU进行呼吸机通气并发生VAP的120例患者为VAP组,纳入同期未发生VAP的120例患者为非VAP组,收集两组一般资料和进入ICU 1,3,5和7天的血清PCT,sTREM-1和YKL-40水平,Logistic回归分析VAP发生的危险因素。将120例VAP患者根据28天的生存情况分为生存组(74例)和死亡组(36例),测定两组患者的PCT,sTREM-1和YKL-40水平,采用ROC曲线图判定其预测价值。结果①VAP组和非VAP组相比较,两组的血清清蛋白水平、血糖水平、APACHE II评分、胃内容物反流、机械通气时间、抗生素使用种类差异均有统计学意义(χ^(2)=13.019,11.793,9.932,8.957,20.057,28.884,均P<0.05),其它资料差异均无统计学意义(P>0.05)。②VAP组和非VAP组1天血清指标差异无统计学意义(t=0.928~1.315,均P>0.05)。与非VAP组相比,VAP组的3,5和7天PCT,sTREM-1和YKL-40水平显著升高(t=15.203~37.340,均P<0.001)。③Logistic回归分析表明:年龄≥60岁,血清清蛋白<30g/L,血糖水平≥7.8mmol/L,广谱抗生素使用种类≥3种,胃内容物反流、气管切开,机械通气时间≥5天,APACHE II评分≥15分,PCT水平升高,sTREM-1水平升高,YKL-40水平升高均是发生VAP的危险因素(χ^(2)=4.404~14.185,均P<0.05)。④生存组和死亡组1天PCT,sTREM-1和YKL-40水平差异无统计学意义(t=1.191,0.842和1.838,均P>0.05),3,5和7天死亡组三个血清学指标显著高于存活组(t=13.342~26.950,均P<0.001)。⑤3,5和7天PCT,sTREM-1,YKL-40水平联合检测均具有较好的敏感度和特异度,对VAP患者的预后均有较高的诊断价值(AUC:0.879~0.945)。结论血清PCT,sTREM-1和YKL-40水平升高是ICU呼吸机通气患者发生VAP的危险因素,临床进行动态监测可对VAP患者的预后进行良好的预测,有效地改善VAP患者的预后生存。
Objective To investigate the significance of serum soluble triggering on myeloid-1(sTREM-1),Procalcitonin(PCT)and human cartilage glycoprotein 39(YKL-40)in patients with Ventilator-associated pneumonia(VAP)and the predictive value of VAP prognosis and the risk factors of VAP.Methods 120 patients with VAP who were ventilated in the ICU of the Third Hospital of Xingtai City,Hebei Province from January 2018 to June 2020 were selected as the VAP group,and 120 patients without VAP during the same period were included as the non-VAP group.General data of the two groups and serum PCT of 1,3,5 and 7d in the ICU were collected.STREM-1 and YKL-40 levels,and Logistic regression was performed to analyze risk factors for VAP.120 patients with VAP were divided into survival group(74 cases)and death group(36 cases)according to their survival at 28 days.Serum PCT,sStreM-1 and YKL-40 levels of the two groups were measured,and their predictive value was determined by ROC curve.Results①Compared with the non-VAP group,there were statistically significant differences in serum albumin level,blood glucose level,APACHEII score,gastric content reflux,mechanical ventilation time and types of antibiotics used between the two groups(χ^(2)=13.019,11.793,9.932,8.957,20.057 and 28.884,all P<0.05),while there were no statistically significant differences in other data(P>0.05).②There was no significant difference in serum indexes between VAP group and non-VAP group on day 1(t=0.928~1.315,all P>0.05),and compared with non-VAP group,PCT,sTREM-1 and YKL-40 levels in VAP group on day 3,5 and 7 were significantly increased(t=15.203~37.340,all P<0.001).③Logistic regression analysis showed that:age≥60 years old,serum albumin<30g/L,blood glucose levels≥7.8mmol/L,broad spectrum antibiotics used≥3,gastric content reflux tracheotomy,mechanical ventilation time≥5day,APACHE II score≥15,PCT,sTM-1 and increased YKL-40 level were risk factors for VAP(χ^(2)=4.404~14.185,all P<0.05).④There were no significant differences in PCT,sTREM-1 and YKL-40 levels between survival group and death group on day 1(t=1.191,0.842 and 1.838,all P>0.05),and the three serologic indexes of death group on day 3,5 and 7 were significantly higher than those of survival group(t=13.342~26.950,all P<0.001).⑤The combined detection of PCT,sTREM-1 and YKL-40 levels at 3,5 and 7d showed good sensitivity and specificity,and had high diagnostic value for the prognosis of VAP patients(AUC:0.879~0.945).Conclusion Elevated serum PCT,sTREM-1 and YKL-40 are risk factors for VAP in ICU patients with ventilator ventilation.Dynamic clinical monitoring of above indexes can predict the prognosis of VAP patients.
作者
王丹
齐连振
贾玉凤
郭萌
代兆华
WANG Dan;QI Lian-zhen;JIA Yu-feng;GUO Meng;DAI Zhao-hua(Department of Clinical Laboratory,the Third Hospital of Xingtai City,Hebei Xingtai 054000,China;Departmen t of Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,Hebei Xingtai 054000,China)
出处
《现代检验医学杂志》
CAS
2021年第5期77-82,共6页
Journal of Modern Laboratory Medicine
基金
河北省邢台市科技计划项目:ICU呼吸机的应用与VAP的风险因素及对策研究(2019ZC341)。
关键词
重症监护室
呼吸机相关性肺炎
可溶性髓系细胞触发受体
降钙素原
人软骨糖蛋白39
intensive care unit
ventilator-associated pneumonia
soluble triggering receptor expressed on myeloid-1
procalcitonin
human cartilage glycoprotein 39