血清PCT、sTREM-1、YKL-40对VAP重症患者预后的预测价值

Prediction value of serum PCT,sTREM-1 and YKL-40 to prognosis of severe VAP

目的研究血清降钙素原(PCT)、可溶性髓系细胞触发受体-1(sTREM-1)、人软骨糖蛋白-40(YKL-40)对呼吸机相关性肺炎(VAP)重症患者预后的预测价值。方法选取VAP重症患者39例(VAP组),未发生VAP重症患者76例(无VAP组),VAP组按预后分为生存组和死亡组。比较各组血清PCT、sTREM-1、YKL-40水平。多因素Logistic回归分析重症患者发生VAP的危险因素,利用ROC曲线分析PCT、sTREM-1、YKL-40联合检测对其预后的诊断效能。结果PCT、sTREM-1、YKL-40水平VAP组高于无VAP组,死亡组高于生存组(P<0.05)。住院时间、机械通气时间、吸痰次数、APACHEⅡ评分、血清蛋白、吸烟史、呼吸道疾病史均是重症患者发生VAP的危险因素。PCT、sTREM-1、YKL-40联合诊断对其预后的诊断效能最高。结论PCT、sTREM-1、YKL-40联合诊断对VAP患者预后具有较高的诊断效能,可作为评估VAP患者预后的参考指标。

Aim To study the prediction value of serum procalcitonin(PCT),soluble triggering receptor expresses on myeloid cells-1(sTREM-1)and human cartilage glycoprotein-40(YKL-40)on theprognosis of patients with severe ventilator associated pneumonia(VAP).Methods 39 patients with severe VAP(VAP group)and 76 patients without VAP(non VAP group)were selected.The VAP group was divided into the survival group and death group according to the prognosis.The serum levels of PCT,sTREM-1 and YKL-40 in each group were compared.Multivariate Logistic regression analysis was used to analyze the risk factors for patients with severe VAP,and ROC curve was used to analyze the diagnostic efficacy of PCT,sTREM-1 and YKL-40 combined detection in the prognosis of VAP patients.Results The levels of PCT,STREM-1 and YKL-40 in the VAP group were higher than non VAP group,and those levels in the death group were higher than survival group(P<0.05).Hospitalization time,mechanical ventilation time,number of sputum suction,APACHEⅡ,serum protein,smoking history and respiratory disease history were risk factors for patients with severe VAP.The combined diagnosis of PCT,sTREM-1 and YKL-40 had the highest diagnostic efficiency for the prognosis of patients with VAP.Conclusion The combined diagnosis of PCT,sTREM-1 and YKL-40 has a high diagnostic efficiency for the prognosis of patients with VAP,which can be used as a reference index to evaluate the prognosis of patients with VAP.