脓毒症患儿血清可溶性髓样细胞触发受体-1、可溶性尿激酶型纤溶酶原激活物受体变化的意义

摘要

目的 探讨血清可溶性髓样细胞触发受体-1(sTREM-1)和可溶性尿激酶型纤溶酶原激活物受体(suPAR)在儿童脓毒症中的表达及临床意义.方法 本研究共纳入全身炎性反应综合征(SIRS)患儿80例.其中脓毒症组60例,非感染SIRS组20例;另选30例健康儿童为健康对照组.采用ELISA法动态监测脓毒症患儿血清sTREM-1、suPAR的水平,观察sTREM-1、suPAR水平在脓毒症与非脓毒症患儿中的差别,并与儿童危重症评分(PC IS)进行相关分析,比较sTREM-1、suPAR、降钙素原(PCT)、C反应蛋白(CRP)等生化指标的敏感性及特异性,评估sTREM-1、suPAR对脓毒症早期诊断及预后判断的价值.结果 脓毒症组血清sTREM-1、suPAR、PCT水平明显高于非感染SIRS组和健康对照组,差异有统计学意义(P＜0.05);而脓毒症组与非感染SIRS组血清CRP水平差异无统计学意义(P＞0.05).在脓毒症各亚组中,血清sTREM-1、suPAR、PCT水平比较差异有统计学意义(P＜0.05).动态监测脓毒症组,发现血清sTREM-1、suPAR、CRP、PCT水平第1、4、7天呈逐渐下降趋势,各时间点比较差异有统计学意义(P＜0.05).脓毒症组血清sTREM-1、suPAR水平与PCIS均呈负相关(r=-0.322、-0.333,P＜0.05).sTREM-1、suPAR、CRP、PCT诊断脓毒症的灵敏度和特异度依次递减,联合sTREM-1和suPAR诊断脓毒症的灵敏度和特异性最高.结论 sTREM-1和suPAR作为炎症感染的指标之一,其表达水平能反映脓毒症严重程度.sTREM-1联合suPAR诊断脓毒症的敏感性和特异性显著优于sTREM-1、suPAR、CRP、PCT等单一指标,联合多个指标可提高诊断的准确性.%Objective To investigate the change and clinical significance of soluble triggering receptor expression of myeloid cells-1 (sTREM-1) and soluble urokinase plasminogen activator receptor (suPAR) expression in children with sepsis.Methods There were 80 systemic inflammatory response syndrome (SIRS)patients who were included in the study,60 cases in the sepsis group,20 cases in the non-infectious SIRS group and 30 cases in the healthy control group.By using the enzyme-linked immunosorbent assay (ELISA)to dynamically monitor the levels of serum sTREM-1,suPAR in children with sepsis,the differences of sTREM-1,suPAR levels between children with sepsis and non-sepsis were observed,the correlation with the pediatric critical illness score(PCIS) was analyzed,and the sensitivity and specificity of sTREM-1,suPAR,C-reactive protein (CRP)and procalcitonin (PCT)and other biochemical markers were compared,and the value of sTREM-1,suPAR,CRP,PCT in the early determination and prognosis of sepsis were investigated.Results Serum sTREM-1,suPAR,PCT levels in sepsis group were significantly higher than non-infectious SIRS group and the healthy control group,and the difference was statistically significant (P ＜ 0.05),but the differences of serum CRP levels in non-infectious SIRS group and sepsis group were not statistically significant(P ＞ 0.05).In sepsis subgroup,serum sTREM-1,suPAR,PCT levels between the three groups were of statistically significant difference (P ＜ 0.05).Through dynamic monitoring of sepsis group,serum sTREM-1,suPAR,CRP,PCT levels had a gradual downward trend in 1,4,7 day,at each time point difference was statistically significant (P ＜ 0.05).Serum sTREM-1,suPAR levels in sepsis group had significant negative correlation with PCIS (r =-0.322,-0.333,P ＜ 0.05).The sensitivity and specificity of sTREM-1,suPAR,CRP,PCT on diagnosing sepsis were in a descending order,and sTREM-1 combined with suPAR has the highest sensitivity and specificity.Conclusions sTREM-1 and suPAR all can serve as indicators of infection and inflammation,as their expression level can reflect the severity of sepsis.sTREM-1 combined with suPAR diagnostic sensitivity and specificity of sepsis was significantly better than a single indicator of sTREM-1,suPAR,CRP,PCT.Combining multiple indicators can improve the accuracy of diagnosis.