不同细菌性血流感染所致脓毒症患者血清PGE2、S1P1和sTREM-1的表达及预后评估价值

Expression and prognostic value of serum PGE2,S1P1 and sTREM-1 in sepsis patients caused by different bacterial bloodstream infections

目的探讨不同细菌性血流感染所致脓毒症患者血清中前列腺素-2(PGE2)、1磷酸鞘氨醇受体1(S1P1)和可溶性髓系细胞触发受体-1(sTREM-1)的表达差异及对患者预后的评估价值。方法选取2018年1月至2020年1月该院重症医学科(ICU)收治的血流感染脓毒症患者165例,按感染细菌的不同分为革兰阳性菌血流感染组(G+血流感染组,50例)和革兰阴性菌血流感染组(G-血流感染组,115例),患者从入住ICU至好转出院或死亡观察期不低于28 d,根据观察期最后一天患者情况分为存活组与死亡组。采用酶联免疫吸附试验(ELISA)法检测各组PGE2、sTREM-1水平,采用化学发光免疫分析仪检测S1P1水平,预后评价采用受试者工作特征(ROC)曲线,各指标间的相关性采用Pearson相关性分析。结果G+血流感染组PGE2、sTREM-1水平均低于G-血流感染组,S1P1水平高于G-血流感染组,差异有统计学意义(P<0.05);存活组PGE2、sTREM-1水平均低于死亡组,S1P1高于死亡组,差异有统计学意义(P<0.05);ROC曲线分析显示,PGE2、S1P1、sTREM-1评估血流感染脓毒症患者预后的曲线下面积(AUC)分别为0.960(95%CI:0.929~0991)、0.962(95%CI:0.928~0.996)、0.979(95%CI:0.957~1.000)。不同细菌性血流感染所致脓毒症患者血清PGE2与S1P1呈负相关,PGE2与sTREM-1呈正相关,S1P1与sTREM-1呈负相关(r=-0.573、0.574、-0.656,均P<0.001)。结论PGE2、S1P1和sTREM-1对血流感染脓毒症患者预后评估价值均较高,可作为血流感染脓毒症患者预后的预测指标。随着病情的加重,血流感染脓毒症患者PGE2水平会升高,sTREM-1水平随之升高,S1P1水平随之下降。

Objective To investigate the expression difference of prostaglandin-2(PGE2),phosphosphingosin-1 receptor-1(S1P1)and soluble myeloid cell trigger receptor-1(sTREM-1)in serum of sepsis patients with different bacterial bloodstream infections and to evaluate their prognosis.Methods A total of 165 patients with bloodstream sepsis admitted to the Intensive Care Unit(ICU)of the hospital From January 2018 to January 2020 were selected and divided into Gram-positive bloodstream infection group(G+bloodstream infection group,50 cases)and Gram-negative bloodstream infection group(G-bloodstream infection group,115 cases)according to the different infected bacteria.The observation period from ICU admission to hospital improvement or death was not less than 28 days,and the patients were divided into survival group and death group according to their conditions on the last day of the observation period.PGE2 and sTREM-1 levels of each group were detected by enzyme-linked immunosorbent assay(ELISA),and S1P1 levels were detected by chemiluminescence immunoanalyzer.Receiver operating characteristic(ROC)curve was used for prognostic evaluation,and the correlation between the indicators was analyzed by Pearson correlation.Results The levels of PGE2 and sTREM-1 in G+bloodstream infection group were lower than those in G-bloodstream infection group,and the level of S1P1 was higher than that in G-bloodstream infection group,with statistical significance(P<0.05).The levels of PGE2 and sTREM-1 in survival group were lower than those in death group,and S1P1 were higher than those in death group,the differences were statistically significant(P<0.05).ROC curve analysis showed that the AUC of PGE2,S1P1 and sTREM-1 to evaluate the prognosis of patients with bloodstream infection sepsis were 0.960(95%CI:0.929-0991),0.962(95%CI:0.928-0.996)and 0.979(95%CI:0.957-1.000),respectively.Serum PGE2 negatively correlated with S1P1 in patients with sepsis caused by different bacterial bloodstream infections,PGE2 positively correlated with sTREM-1,and S1P1 negatively correlated with sTREM-1(r=-0.573,0.574,-0656,all P<0.001).Conclusion PGE2,S1P1 and sTREM-1 all have high prognostic values for patients with bloodstream infection sepsis,and can be used as prognostic indicators for patients with bloodstream infection sepsis.With the aggravation of the disease,the level of PGE2 and sTREM-1 increase,while the level of S1P1 decrease.