目的 探讨可溶性髓系细胞触发受体-1(sTREM-1)、可溶性血红蛋白清道失受体(sCD163)等指标对诊断脓毒症及评估脓毒症严重程度的价值,为临床脓毒症的诊断及治疗提供可靠依据.方法 70例入住ICU时疑似脓毒症的患者,按2001年脓毒症诊断标准分为脓毒症组(A组,n=51)和非脓毒症组(B组,n=19).脓毒症组(A组)再按病情严重程度分为一般脓毒症组(A1组,n=19)、严重脓毒症组(A2组,n=19)和脓毒症休克组(A3组,n=13)3个亚组.另收集20例健康体检者作为对照组(C组).A组患者分别于入住ICU第1、3、7天(B组仅在第1天,C组在体检时)采集外周血,ELISA方法检测sTREM-1和sCD163表达水平,并送检验科检测降钙素原(PCT)、C反应蛋白(CRP)和白细胞计数(WBC).结果 A组患者第1天sTREM-1、sCD163、PCT表达水平均显著高于B组(P＜0.01),但两组间CRP水平差异无统计学意义(P =0.116).亚组相同时间点比较,A2组第1、3天sTREM-1和第1、3、7天sCD163水平均显著高于A1组(P ＜0.05)；A3组第1、3、7天sTREM-1、sCD163、PCT水平均显著高于A1组(P ＜0.05)；A2组第1、3、7天PCT水平与A1组比较差异无统计学意义(P＞0.05).sTREM-1与sCD163呈显著正相关(r=0.632).sTREM-1、sCD163s、sTREM-1+ sCD163(串联)诊断脓毒症的AUC分别为0.911、0.913、0.934,均显著高于PCT、CRP和WBC.结论 sTREM-1、sCD163、PCT等指标均能敏感反映机体脓毒症状态,sTREM-1和sCD163显著优于PCT、CRP、WBC等指标,且两者呈显著正相关关系,表明sTREM-1+ sCD163(串联)可作为诊断脓毒症的可靠指标.%Objective To analyze the application of sTREM - 1 and sCD163 in the diagnosis and severity evaluation of sepsis. Methods A total of 70 patients, who were suspected sepsis when admitted to the ICU, were divided into sepsis group (Group A, n = 51) and non -sepsis group (Group B, n = 19) according to 2001 sepsis diagnosis criteria. The subjects in sepsis group (Group A) were subdivided into three sub - groups, such as general sepsis group (Group Al, n = 19), severe sepsis group (Group A2, n = 19) and septic shock group (GroupA3, n = 13) according to the severity of the disease. Twenty healthy people were enrolled as the control group (Group C, n - 19 ). Peripheral blood of patients in Group A was collected on Day 1st, 3rd, and 7th, while in Group B on Day 1st and in Group C at physical examination. The expression of sTREM - 1 and sCD163 was assessed by ELISA, whereas procalcitonin ( PCT) , C - reactive protein (CRP) and white blood cell count ( WBC) were measured in clinical laboratory. Results The expression of sTREM - 1, sCD163 and PCT in Group A was significantly higher than that in Group B ( P < 0. 01) on Day 1 st, while there was no significant difference revealed in CRP between the two groups (P =0. 116). The sTREM - 1 on Day 1st, 3rd and sCD163 on Day 1st, 3rd, 7th in Group A2 were significantly higher than those in Group Al (P < 0. 05). The sTREM - 1 , sCD163 and PCT on Day 1st, 3rd, 7th in Group A3 were significantly higher than those in Group Al (P < 0.05). However, there was no significant difference in PCT between Group A2 and Group Al (P >0. 05). There was significantly positive correlation between sTREM - 1 and sCDl63 ( r = 0. 632). According to the ROC of sepsis diagnosis, The AUCs of sTREM - 1 , sCD163 and sTREM - 1 + sCD163 were 0. 911, 0. 913 and 0. 934, respectively, which were all higher than PCT, CRP or WBC. Conclusion It is sensitive to use sTREM - 1, sCD163 , PCT in sepsis diagnosis and e-valuation. Among them sTREM - 1 and sCD163 are superior to PCT CRP, and WBC. The sTREM - i is significantly associated with sCD163, thus providing reliable indicator in the clinical diagnosis of sepsis.
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