TLR4、TREM1在烧伤感染患者血清中的表达水平及其诊断价值

The expression and diagnostic significance of TLR4 and TREM1 in the serum of patients with burn infection

目的探究血清Toll样受体4(TLR4)、髓样细胞触发受体1(TREM1)在烧伤感染患者血清中的表达情况及诊断价值。方法收集78例烧伤科住院病例为研究对象(研究组),同期健康体检者80例作为对照(对照组);研究组分为3个亚组:脓毒症患者为重症感染组(n=18)、局部感染为局部感染组(n=37)、单纯烧伤未发生感染为未感染组(n=23)。酶联免疫吸附试验(ELISA)检测血清中TLR4、TREM1水平;Pearson分析烧伤患者血清中TLR4与TEEM1的相关性;绘制受试者工作特性曲线(ROC曲线)分析TLR4、TEEM1对烧伤患者感染的诊断价值。结果与对照组相比,研究组血清中TLR4、TREM1水平升高(P<0.05)。与重症感染者相比,局部感染者、未感染组血清中TLR4、TREM1水平降低(P<0.05);与局部感染者相比,未感染组血清中TLR4、TREM1水平降低(P<0.05)。Pearson分析烧伤患者血清中TLR4与TREM1呈正相关(r=0.526,P<0.05)。ROC曲线显示,血清TLR4、TREM1水平预测烧伤患者感染的ROC曲线下面积分别为0.825、0.801,截断值为4.686 ng/mL、242.482 ng/L,其敏感度为65.45%、81.82%,特异度为91.30%、69.57%、准确度为73.08%、78.21%;两者联合预测烧伤患者感染的ROC曲线下面积为0.911,敏感度为87.27%、特异度为86.96%、准确度为87.18%。与血清TREM1水平相比,TLR4+TREM1 ROC曲线下面积升高(Z=1.659,P=0.048)。血清TLR4水平敏感度、准确度均低于TLR4+TREM1(P<0.05)。结论烧伤感染患者血清中TLR4、TREM1水平升高,两者联合对烧伤感染患者具有较高的诊断价值,在临床上具有一定参考价值。

Objective To investigate the expression and diagnostic value of serum Toll-like receptor 4(TLR4) and triggering receptor expressed on myeloid cell 1(TREM1) in the serum of patients with burn infection. Methods A total of 78 inpatients in the burn department were collected as the research objects(study group), and 80 healthy patients during the same period were served as the control group. The study group was divided into three subgroups, severely infected group(sepsis patients, n=18), locally infected group(patients with local infection, n=37), and uninfected group(patients with simple burns without infection, n=23). Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of TLR4 and TREM1 in serum. Pearson analysis was used to analyze the correlation between TLR4 and TEEM1 in the serum of burn patients. Receiver operating characteristic curve(ROC) was drawn to analyze the diagnostic value of TLR4 and TEEM1 for infection in burn patients. Results Compared with the control group, the levels of serum TLR4 and TREM1 in the study group were significantly increased(P<0.05). Compared with severely infected group, the levels of serum TLR4 and TREM1 in locally infected group and uninfected group were significantly reduced(P<0.05). Compared with locally infected group, the levels of serum TLR4 and TREM1 in uninfected group were significantly reduced(P<0.05). Pearson analysis showed there was a significant positive correlation between TLR4 and TREM1 in serum of burn patients(r=0.526, P<0.05). The ROC curve showed that the area under the ROC curve for predicting infection in burn patients by serum TLR4 and TREM1 levels were 0.825 and 0.801, respectively;with cut-off value of 4.686 ng/mL and 242.482 ng/L, respectively;the sensitivities were 65.45% and 81.82%, respectively;the specificities were 91.30% and 69.57%, respectively;and the accuracies were 73.08% and 78.21%, respectively. The area under the ROC curve for the combined prediction of infection in burn patients was 0.911, the sensitivity was 87.27%, the specificity was 86.96%, and the accuracy was 87.18%. Compared with serum TREM1 level, the area under the ROC curve of TLR4+TREM1 was significantly increased(Z=1.659, P=0.048). The sensitivity and accuracy of serum TLR4 level were significantly lower than those of TLR4+TREM1(P<0.05). Conclusion The levels of TLR4 and TREM1 in the serum of patients with burn infection are elevated. The combination of the two has a high diagnostic value for patients with burn infection, and has certain reference value in clinical practice.