脊髓损伤术后泌尿系感染患者CRP/ALB、sTREM-1、CD64水平变化及临床意义

Changes and clinical significance of CRP/ALB, sTREM-1 and CD64 in urinary tract infection patients after spinal cord injury

目的 探讨C-反应蛋白与白蛋白比值(CRP/ALB)、可溶性髓系细胞触发受体1(sTREM-1)、CD64在脊髓损伤术后泌尿系感染中的变化及意义。方法 选取2015年1月-2020年12月华中科技大学同济医学院附属梨园医院收治的122例行外科手术治疗的脊髓损伤患者,根据术后4周内是否发生泌尿系感染分为感染组(n=31)、非感染组(n=91),比较两组一般资料、术前、术后1 d、术后3 d CRP/ALB、sTREM-1、CD64水平,应用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析各指标预测泌尿系感染的价值,并比较各指标不同表达水平患者感染率。结果 感染组糖尿病患者占比及术后1 d、术后3 d CRP/ALB、sTREM-1、CD64高于未感染组(P<0.05);术后3 d CRP/ALB、sTREM-1、CD64预测泌尿系感染的AUC高于术后1 d CRP/ALB、sTREM-1、CD64,术后3 d各指标联合的AUC高于术后1 d各指标联合的AUC;CRP/ALB、sTREM-1、CD64高危患者感染率高于低危患者(P<0.05)。结论 脊髓损伤术后泌尿系感染患者术后1、3 d CRP/ALB、sTREM-1、CD64持续升高,均与泌尿系感染有关,在缺乏有效评估方法时,可作为预测泌尿系感染的生物标志物,为临床诊治、干预提供参考依据。

OBJECTIVE To investigate the dynamic changes and significance of C-reactive protein to albumin ratio(CRP/ALB), soluble myeloid cell trigger receptor 1(sTREM-1), and CD64 levels in urinary tract infections after spinal cord injury. METHODS A total of 122 patients with spinal cord injury under surgical treatment in our hospital from Jan 2015 to Dec 2020 were recruited. According to whether urinary tract infection occurred within 4 weeks after operation, they were divided into the infection group(n=31) and non-infection group(n=91). The general data of the two groups, the levels of CRP/ALB, sTREM-1 and CD64 before operation, 1 day after operation, and 3 days after operation were compared. Receiver operating characteristic curve(ROC) and area under ROC(AUC) were used to analyze the value of each index in predicting urinary tract infection. And the infection rates of people with different expression levels of each index were compared. RESULTS The proportion of diabetic patients, CRP/ALB, sTREM-1 and CD64 levels 1 and 3 days after operation in the infected group were significantly higher than those in the non-infection group(P<0.05). The AUCs of CRP/ALB, sTREM-1, and CD64 predicting urinary tract infection on the 3 rd postoperative day were significantly larger than those on 1 st day after surgery. The infection rate of patients with high levels of CRP/ALB, sTREM-1, CD64 was significantly higher than those with low levels(P<0.05). CONCLUSION Levels of CRP/ALB, sTREM-1 and CD64 continued to increase in patients with urinary tract infection after spinal cord injury on 1 st and 3 rd days after surgery, which are independent influencing factors for urinary tract infection. The indexes can be used as biomarkers of urinary tract infection in the absence of effective evaluation methods, providing reference for clinical diagnosis, treatment and intervention.