目的 探讨血清可溶性髓系细胞表达触发蛋白-1(sTREM-1)及中性粒细胞表面CD64表达水平对脓毒症的早期诊断价值.方法 应用双抗体夹心酶联免疫吸附法(ELISA)测定血清sTREM-1浓度,应用流式细胞技术测定中性粒细胞表面分子CD64的表达,应用受试工作特征ROC曲线研究sTREM-1、CD64的诊断效能.结果 脓毒症组、SIRS组与健康对照组血清sTREM-1中位数水平分别为255.34、184.58和128.64 pg/mL,三组间比较,差异有统计学意义,P<0.01;脓毒症组CD64阳性百分率中位数为79.96%,高于SIRS组和健康对照组(分别为47.50%、16.37%),三组间比较差异有统计学意义,P<0.05.血清sTREM-1诊断脓毒症ROC曲线下面积为0.75,在临界值取208.86时sTREM-1诊断脓毒症的敏感性74%,特异度70%.CD64阳性百分率以57.83%为界时,诊断脓毒症的敏感度为85%,特异度为75%,ROC曲线下面积为0.77.2项指标联合检测,ROC曲线下面积为0.86,敏感性达90%,特异性为62%.结论 外周血sTREM-1、中性粒细胞表面CD64检测对于脓毒症的诊断及鉴别具有一定价值,两者联合检测对早期诊断可能更具意义.%Objective To investigate the diagnostic value of serum soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) and CD64 expression on the surface of neutrophil in patients with sepsis .Methods sTREM-1 was measured by double-antibody sandwich enzyme-linked immunosorbent assay (EL1SA ) .CD64 was measured by automatic flow cytometry .The diagnostic value of sTREM-1 and CD64 were assessed by receiver operating characteristic (ROC) curve analysis .Results Median concentrations of Serum sTREM-1 in sepsis ,non-infectious SIRS and control groups were 255 .34 ,184 .58 and 128 .64 pg/mL ,respectively .Level of sTREM-1 in patients with sepsis was significantly higher than in patients with non-infectious SIRS and control group(P <0 .01) .Level of peripheral blood neutrophil CD64 in sepsis group(79 .96% ) was significantly higher than that in the other two groups (47 .50% and 16 .37% ,P<0 .05 ) .The area under ROC curve of sTREM-1 for the diagnosis of sepsis was 0 .75 ,taking cut-off level of 208 .86 pg/mg ,with sensitivity of 74/o and specificity of 70/o .At cut-off level of 57 .83/o ,the sensitivity and specificity of CD64 were 85/o and 75/o respectively ,and the area under ROC curve for the diagnosis of sepsis was 0 .77 .The area under ROC curve of combination was 0 .86 .Conclusion Serum sTREM-1 and CD64 detection might have diagnostic value for sepsis .Combined detection might be with better diagnostic value .
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