肺部超声联合CRP、PCT、sTREM-1检测及CPIS评分在呼吸机相关性肺炎早期诊断中的价值

The application of pulmonary ultrasound combined with CRP,PCT,sTREM-1 detection and CPIS score in the early diagnosis of ventilator-associated pneumonia

目的探讨肺部超声联合C-反应蛋白(CRP)、降钙素原(PCT)、可溶性髓系细胞触发受体-1(sTREM-1)检测及临床肺部感染评分(CPIS评分)在呼吸机相关性肺炎(VAP)早期诊断中的应用价值。方法选取2018年1月至2021年6月合肥市第二人民医院收治的临床疑诊为VAP患者125例作为研究对象,根据胸部CT与气道分泌物细菌半定量培养结果将其分为VAP组56例与非VAP组69例。比较两组患者肺部超声检查结果与CRP、PCT、sTREM-1水平及CPIS评分,CPIS评分与CRP、PCT、sTREM-1水平的相关性采用Spersman等级相关分析,并采用受试者特异曲线(ROC)曲线评价肺部超声与CRP、PCT、sTREM-1水平及CPIS评分对VAP的诊断效果。结果VAP组患者CRP、PCT、sTREM-1水平明显高于非VAP组,差异有统计学意义(P<0.05)。VAP患者CPIS评分与CRP、PCT、sTREM-1水平呈正相关性(r=0.705、0.562、0.781,均P<0.05)。VAP组患者肺部超声与CRP、PCT、sTREM-1及CPIS评分单项及联合检测阳性检出率均高于非VAP组,差异有统计学意义(P<0.05);两组患者肺部超声与CRP、PCT、sTREM-1及CPIS评分联合诊断阳性检出率均分别明显高于单项检测(P<0.05)。ROC曲线分析显示肺部超声联合CRP、PCT、sTREM-1及CPIS评分诊断VAP的AUC值0.962、灵敏度98.21%及特异度94.20%,均大于90%,其阳性似然比、阴性似然比分别为16.94、0.02。结论肺部超声联合CRP、PCT、sTREM-1检测及CPIS评分对VAP早期诊断有较高灵敏度与特异度,且CPIS评分与CRP、PCT、sTREM-1水平呈正相关性,可作为VAP早期诊断的辅助手段。

Objective To investigate the application value of pulmonary ultrasound combined with C-reactive protein(CRP),procalcitonin(PCT),soluble triggering receptor expressed on myeloid cells-1(sTREM-1)detection and clinical pulmonary infection score(CPIS score)in the early diagnosis of ventilatorassociated pneumonia(VAP).Methods 125 patients with suspected VAP admitted to our hospital from January 2018 to June 2021 were selected as the study subjects,according to the results of semi-quantitative culture of bacteria in chest CT and airway secretions,they were divided into the VAP group(56 cases)and the non-VAP group(69 cases).The lung ultrasonography results,CRP,PCT,sTREM-1 levels and CPIS scores were compared between the two groups.The correlation between CPIS scores and CRP,PCT,and sTREM-1 levels was analyzed by Spersman rank correlation analysis,and the subject-specific curve(ROC)curve was used to evaluate the diagnostic effect of lung ultrasound,CRP,PCT,sTREM-1 levels and CPIS score in the diagnosis of VAP.Results CRP,PCT and sTREM-1 in the VAP group were significantly higher than those in the non-VAP group(P<0.05).The Spersman grade correlation analysis showed that CPIS scores of VAP patients were positively correlated with CRP,PCT and sTREM-1 levels(P<0.05).The positive detection rates of lung ultrasound,CRP,PCT,sTREM-1 and CPIS scores in the VAP group were higher than those in the nonVAP group(P<0.05).The positive detection rates of lung ultrasound combined with CRP,PCT,sTREM-1 and CPIS scores in the two groups were significantly higher than those of single test(P<0.05)The ROC curve analysis showed that the AUC value of lung ultrasound combined with CRP,PCT,sTREM-1 and CPIS scores for the diagnosis of VAP was 0.962,the sensitivity was 98.21%and the specificity was 94.20%,which were all greater than 90%.The positive and negative likelihood ratios were 16.94,0.02 respectively.Conclusion Pulmonary ultrasound combined with CRP,PCT,sTREM-1 detection and CPIS score has high sensitivity and specificity for the early diagnosis of VAP,and the CPIS score is positively correlated with the levels of CRP,PCT and sTREM-1,which can be used as an assistant means for the early diagnosis of VAP.