胸腔积液患者病原菌分布及胸水中sTREM-1、Presepsin水平对良恶性的诊断价值

Distribution of pathogens in patients with pleural effusion and the diagnostic value of sTREM-1 and Presepsin levels in pleural effusion for benign and malignant pleural effusion

目的 探究胸腔积液患者病原菌分布及胸水中可溶性髓系细胞触发受体-1(sTREM-1)、可溶性白细胞分化抗原14亚型(Presepsin)水平对良恶性的诊断价值。方法 选择本院诊治的胸腔积液患者,其中良性胸水67例记为良性组,恶性胸水133例记为恶性组。全自动细菌鉴定及药敏分析仪对患者胸水中病原菌分布进行鉴定,全自动生化分析仪检测患者肌酐(Cre)、白蛋白(Alb)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、癌胚抗原(CEA)、免疫球蛋白G(IgG)水平。ELISA检测患者C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)(88-7346-88)、降钙素原(PCT)、sTREM-1、Presepsin水平。多因素Logistic回归分析胸水良恶性的影响因素;Pearson相关性分析sTREM-1、Presepsin水平与生化指标、炎症指标的相关性;ROC曲线分析sTREM-1、Presepsin水平对恶性胸水的诊断价值,Z检验比较AUC的差异。结果 200例胸水样本中,共检测出384株病原菌,结核分歧杆菌占比最高,为55.99%;恶性组Alb、Cre水平降低,ADA、CEA、CRP、TNF-α、PCT、sTREM-1、Presepsin水平升高(P<0.05);sTREM-1、Presepsin水平与Alb水平呈负相关,与ADA、CRP、TNF-α、PCT水平呈正相关(P<0.05);sTREM-1、Presepsin诊断恶性胸腔积液的AUC为0.809、0.813,联合诊断的AUC为0.922,优于各自单独诊断(Z_(两者联合-sTREM-1)=4.506、Z_(两者联合-Presepsin)=2.957,均P<0.05)。结论 恶性胸水中,sTREM-1、Presepsin水平升高,并与生化指标和炎症指标水平相关,两者联合诊断患者恶性胸水价值高于单独诊断,为临床诊断提供理论支持。

Objective To investigate the distribution of pathogens in patients with pleural effusion and the diagnostic value of soluble triggering receptor expressed on myeloid cells-1(sTREM-1)and soluble cluster of differentiation 14 subtype(Presepsin)levels in pleural effusion for benign and malignant pleural effusion.Methods This study selected patients with pleural effusion who were treated in our hospital,among them,67 cases of benign pleural effusion were recorded as the benign group,and 133 cases of malignant pleural effusion were recorded as the malignant group.Fully automated bacterial identification and drug sensitivity analyzer were applied to identify the distribution of pathogens in the pleural effusion.Fully automated biochemical analyzer was applied to detect the levels of creatinine(Cre),albumin(Alb),lactate dehydrogenase(LDH),adenosine deaminase(ADA),carcinoembryonic antigen(CEA),and immunoglobulin G(IgG)in patients.ELISA was applied to detect levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),procalcitonin(PCT),sTREM-1,and Presepsin in patients.Multivariate logistic regression was applied to analyze the influencing factors of benign and malignant pleural effusion.Pearson correlation was applied to analyze the correlation between sTREM-1,Presepsin levels and biochemical and inflammatory indicators.The ROC curve was applied to analyze the diagnostic value of sTREM-1 and Presepsin levels for malignant pleural effusion.Z-test was applied to compare the differences in AUC.Results Out of 200 pleural effusion samples,a total of 384 strains of pathogens were detected,with the highest proportion being Mycobacterium tuberculosis,accounting for 55.99%.The levels of Alb and Cre decreased in the malignant group,while the levels of ADA,CEA,CRP,TNF-α,PCT,sTREM-1,and Presepsin increased(P<0.05).The levels of sTREM-1 and Presepsin were negatively correlated with the level of Alb,and positively correlated with the levels of ADA,CRP,TNF-α,and PCT(P<0.05).The AUC of sTREM-1 and Presepsin in diagnosing malignant pleural effusion was 0.809 and 0.813,while the AUC of the combined diagnosis was 0.922,which was better than their respective individual diagnoses(Z.ombimiosTREM1=4.506,ZoombiniopPepin=2.957,both P<0.05).Conclusion In malignant pleural effusion,the levels of sTREM-1 and Presepsin are elevated and correlated with biochemical and inflammatory markers.The combined diagnosis for malignant pleural effusion is more valuable than individual diagnosis,providing theoretical support for clinical diagnosis.