可溶性髓系细胞触发受体-1对呼吸机相关肺炎早期诊断及预后的判断价值

摘要

目的：探讨血清及呼出气冷凝液（EVC）中可溶性髓系细胞触发受体-1（sTREM-1）对呼吸机相关性肺炎（VAP）早期诊断及预后判断的临床价值。方法对37例机械通气患者进行治疗后评估，分成非感染组13例，感染组24例（其中治疗有效组14例，治疗无效组10例），所有患者均在机械通气后第1、3、5、7天应用双抗体夹心酶联免疫吸附法（DAS-ELISA）测定血清和 EVC 中 sTREM-1水平，并记录下呼吸道分泌物细菌培养结果和患者治疗后转归；应用受试者工作特征曲线（ROC）研究 sTREM-1对 VAP 早期诊断效能及预后判断价值。结果第1天，血清及 EVC 中 sTREM-1水平治疗有效组、治疗无效组及非感染组比较，差异无统计学意义（P ＞0．05）；第3天和第5天，感染组较非感染组有明显升高（P ＜0．01）；第7天，治疗无效组仍处较高水平，与治疗有效组、非感染组比较差异有统计学意义（P ＜0．01），而治疗有效组与非感染组比较差异无统计学意义（P ＞0．05）。应用 ROC 分析，第3天血清和 EVC 中 sTREM-1曲线下面积分别为0．897、0．909。以第3天 EVC 中sTREM-14．70 ng/mL 为 VAP 的早期诊断界值，其诊断灵敏度为95．8％，特异度为92．3％。结论血清和 EVC 中sTREM-1检测有助于 VAP 的早期诊断，第7天血清和 EVC 中 sTREM-1水平有助于判断 VAP 的预后（撤机失败和死亡），与血清标本比较，EVC 的获得更加方便。%Objective This study examined the value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)in serum and exhaled ventilator condensate (EVC)in early diagnosis and prognosis of ventilator-associated pneumonia (VAP). Methods A total of 37 adult patients undergoing mechanical ventilation were evaluated after treatment,including 24 patients with infection,13 without infection.Of the 24 patients with infection,10 patients were assigned to ineffective subgroup and 14 to effective subgroup.Levels of sTREM-1 in serum and EVC were measured on days 1,3,5,and 7 for all patients.sTREM-1 in serum and EVC were determined in patients by double antibody sandwich enzyme-linked immunosorbant assay (DAS-ELISA).The early diagnostic and prognostic value was assessed by receiver operating characteristic (ROC)curve analysis.Re-sults On Day 1,the sTREM-1 levels in serum and EVC did not show significant difference between the three groups (P>0.05).On Day 3 and Day 5,the level of sTREM-1 in the infection group was higher than that in the non-infection group (P <0.01).On Day 7,the sTREM-1 levels of serum and EVC in ineffective subgroup were higher than those in the effective subgroup and non-infection group (P <0.01). There were no difference between the non-infection group and effective subgroup (P >0.05).For ROC analysis,area under the curve (AUC)of serum sTREM-1 was 0.897,and AUC of EVC sTREM-1 was 0.909 on Day 3.When the cut-off value of EVC sTREM-1 was set at 4.70 ng/mL on Day 3,the sensitivity was 85.8%,specificity was 92.3%.Conclusions The results suggest that the levels of sTREM-1 in serum and EVC are conducive to the early diagnosis of VAP.The levels of sTREM-1 in serum and EVC on Day 7 are helpful for estimating the prognosis.EVC sample is easier to collect than serum.