纤维支气管镜肺泡灌洗液中sTREM-1、IL-32及PCT水平对呼吸机相关性肺炎病情及预后判断的价值

The value of sTREM-1,IL-32,and PCT levels in fiberoptic bronchoscopic alveolar lavage fluid on the condition and prognosis of ventilator-associated pneumonia

目的:探讨纤支镜支气管肺泡灌洗液中可溶性髓系细胞触发受体-1(sTREM-1)、白细胞介素32(IL-32)及降钙素原(PCT)水平与呼吸机相关肺炎(VAP)患者病情及预后判断的价值。方法:选取确诊的53例VAP患者作为VAP组;另选取同期实施机械通气但是未发生VAP的56例患者作为对照组。记录两组患者肺泡灌洗液中sTREM-1、IL-32、PCT水平、CPIS评分、APACHEⅡ评分,并探究其与患者病情和预后的相关性。结果:VAP组患者肺泡灌洗液sTREM-1、IL-32、PCT水平及CPIS评分、APACHEⅡ评分均高于对照组(P<0.05);VAP组患者肺泡灌洗液的sTREM-1、IL-32、PCT水平与CPIS评分正相关(r=0.614、0.603、0.621,P<0.05);VAP组患者肺泡灌洗液的sTREM-1、IL-32、PCT水平与APACHEⅡ评分正相关(r=0.414、0.463、0.409,P<0.05);53例VAP患者,经过28 d治疗,死亡17例、存活36例,死亡的VAP患者肺泡灌洗液sTREM-1、IL-32、PCT水平及CPIS评分、APACHEⅡ评分均高于存活组(P<0.05);肺泡灌洗液sTREM-1、IL-32、PCT水平预测VAP患者不良预后结局的受试者工作曲线下面积(AUC)分别为0.900、0.862、0.917。结论:VAP患者肺泡灌洗液中sTREM-1、IL-32、PCT水平升高,并且与患者肺部感染程度、病情危重程度正相关,对于预测患者不良结局具有较高的价值。

Objective:To explore the value of soluble myeloid cell trigger receptor-1(sTREM-1),interleukin-32(IL-32),procalcitonin(PCT)levels in bronchoalveolar lavage fluid and the condition and prognosis of patients with ventilator-related pneumonia(VAP).Methods:A total of 53 patients with confirmed VAP were selected as the VAP group,and 56 patients who were mechanically ventilated but did not develop VAP were selected as the control group for clinical study.The levels of sTREM-1,IL-32,PCT,CPIS score and APACHE II were recorded in the alveolar lavage fluid of two groups and to explore their correlation with the patient's condition and prognosis.Results:The levels of sTREM-1,IL-32 and PCT,CPIS and APACHEⅡscores in the VAP group were higher than those in the control group(P<0.05).The levels of sTREM-1,IL-32,PCT in the alveolar lavage fluid of patients in the VAP group were positively correlated with the CPIS score(r=0.614,0.603,0.621,P<0.05).The levels of sTREM-1,IL-32,PCT in the alveolar lavage fluid of patients in the VAP group were positively correlated with the APACHE II score(r=0.414,0.463,0.409,P<0.05).53 patients with VAP,After 28 days of treatment,17 died and 36 survived,the level of sTREM-1,IL-32 and PCT,CPIS score and APACHEⅡscore in alveolar lavage fluid with dead VAP patients were higher than those in the surviving group(P<0.05).AUC values under the ROC area of sTREM-1,IL-32 and PCT level predicting poor outcome in patients with VAP were 0.900,0.862 and 0.917,respectively.Conclusion:The levels of sTREM-1,IL-32 and PCT of the BAL lavage fluid in VAP patients will increase,and they are positively correlated with the degree of pulmonary infection and the critical degree of the disease of the patients,which has a high value for predicting the adverse prognosis outcome of patients.