D-二聚体、前白蛋白、可溶性髓系细胞触发受体-1对儿童重症肺炎的诊断价值

Values of D-dimer,prealbumin and soluble triggering receptor expressed on myeloid cells-1 in diagnosing severe pneumonia in children

目的 分析血清D-二聚体(D-D)、前白蛋白(PA)、可溶性髓系细胞触发受体-1(sTREM-1)联合检测诊断儿童重症肺炎的价值。方法 将70例住院肺炎患儿根据疾病严重程度分为重症肺炎组与普通肺炎组,每组35例;重症肺炎组又根据住院期间预后情况分为存活亚组30例与死亡亚组5例。采用酶联免疫吸附(ELISA)检测sTREM-1水平,采用免疫比浊法检测血清D-D、PA水平;采用受试者工作特征(ROC)曲线分析血清D-D、PA、sTREM-1联合检测对儿童重症肺炎的诊断价值;采用Logistic回归模型分析血清D-D、PA、sTREM-1对重症肺炎发生的影响。结果 普通肺炎组入院时血清D-D、sTREM-1水平低于重症肺炎组,血清PA水平高于重症肺炎组,差异有统计学意义(P<0.05)。血清D-D、PA、sTREM-1及其联合诊断儿童重症肺炎的曲线下面积(AUC)分别为0.849、0.858、0.833、0.986。存活亚组入院治疗后血清D-D、sTREM-1水平逐渐降低,血清PA水平逐渐升高,差异有统计学意义(P<0.01);死亡亚组入院治疗后血清D-D、sTREM-1水平逐渐升高,血清PA水平逐渐降低,差异有统计学意义(P<0.01)。入院时、入院3 d及入院1周时,死亡亚组血清D-D、sTREM-1水平均高于存活亚组,血清PA水平低于存活亚组,差异有统计学意义(P<0.01)。sTREM-1升高是重症肺炎发生的独立危险因素(P<0.05)。结论 重症肺炎患儿血清D-D、sTREM-1水平升高,PA水平降低,3项指标联合检测不仅可以提高重症肺炎的早期诊断率,而且也能指导疗效评估。

Objective To analyze the value of combined detection of serum D-dimer(D-D),prealbumin(PA)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)in diagnosing severe pneumonia in children.Methods A total of 70 hospitalized children with pneumonia were divided into severe pneumonia group and common pneumonia group according to severity of disease,with 35 cases in each group;the severe pneumonia group was divided into survival subgroup with 30 cases and death subgroup with 5 cases according to the prognosis during hospitalization.Enzyme-linked immunosorbent assay(ELISA)was used to detect the level of sTREM-1,and immunoturbidimetry was used to detect the levels of serum D-D and PA;the receiver operating characteristic(ROC)curve was used to analyze the value of combined detection of serum D-D,PA and sTREM-1 in diagnosing severe pneumonia in children;the Logistic regression model was used to analyze the effects of serum D-D,PA and sTREM-1 on the occurrence of severe pneumonia.Results The levels of serum D-D and sTREM-1 at hospital admission in the common pneumonia group were significantly lower than those in the severe pneumonia group,while the level of serum PA was significantly higher than that in the severe pneumonia group(P<0.05).Values of the area under the curve(AUC)of serum D-D,PA,sTREM-1 and their combined detection for diagnosis of severe pneumonia in children were 0.849,0.858,0.833 and 0.986 respectively.After treatment in hospital,the levels of D-D and sTREM-1 in the survival subgroup significantly gradually decreased,while the level of serum PA significantly gradually increased(P<0.01);the levels of D-D and sTREM-1 in the death subgroup gradually increased after treatment in hospital,while the level of serum PA gradually decreased(P<0.01).At the time points of hospital admission,3 days after admission and 1 week after admission,the serum D-D and sTREM-1 levels in the death subgroup were significantly higher than those in the survival subgroup,while the serum PA levels were significantly lower than that in the survival subgroup(P<0.01).The increased sTREM-1 was an independent risk factor for occurrence of severe pneumonia(P<0.05).Conclusion In the children with severe pneumonia,the levels of serum D-D and sTREM-1 increase,while the level of PA decreases,and the combined detection of the three indicators can not only increase the early diagnosis rate of severe pneumonia,but also guide the efficacy evaluation.