引流液sTREM-1早期预测腹部多发伤继发脓毒症的临床价值

摘要

目的 探讨引流液可溶性髓系细胞触发受体-1 (sTREM-1)预测腹部多发伤继发脓毒症的临床价值.方法 选取医院收治的175例腹部多发伤患者作为研究对象,根据治疗过程中是否继发脓毒症分组,其中114例继发脓毒症作为脓毒症组,61例未继发脓毒症作为对照组.所有患者在入院后24 h内均检测引流液和血清sTRE M-1、C反应蛋白(CRP)、降钙素原(PCT)等,比较两组检测结果.结果 (1)脓毒症组引流液和血清sTREM-1水平均显著高于对照组(P＜0.05);两组血清CRP和PCT比较无统计学差异(P＞0.05).(2)引流液sTREM-1诊断预测继发脓毒症的敏感度、特异度、截断值(Cut-off)、ROC曲线下面积(A UC)、曲线下面积95％ CI分别为78.24％、83.57％、77.91μg/L、0.85(最接近1.0)、0.795～0.917,受试者工作特征曲线(ROC曲线)分析显示,引流液sTREM-1诊断腹部多发伤继发脓毒症的ROC曲线下面积(AUC)显著高于血清sTREM-1、血清CRP、血清PCT,差异均具有统计学意义(P＜0.05),提示引流液sTREM-1预测继发腹源性脓毒症效果最为显著.结论 引流液和血清sTREM-1均可用于腹部多发伤继发脓毒症的早期预测,但是引流液sTREM-1的临床预测价值更高.%Objective To explore the clinical value of drainage fluid soluble medullary cell trigger receptor-1(sTREM-1) in early prediction of secondary sepsis of multiple abdominal injuries.Methods A total of 175 patients with multiple abdominal injuries admitted to our hospital were selected as study subjects and divided into a sepsis group (n=114) and a control group (n=61) according to whether secondary sepsis occurred in the process of treatment.The drainage fluid and serum sTREM-1,c-reactive protein (CRP),procalcitonin (PCT) and other indexes of all patients were detected within 24 hours upon the admission.The detection results between the two groups were compared.Results (1)The levels of drainage fluid and serum sTREM-1 in the sepsis group were significantly higher than those in the control group(P ＜ 0.05);the serum CRP and PCT showed no statistical difference between the two groups (P ＞ 0.05).(2)The sensitivity,specificity,cut-off,area under curve (A UC) of ROC and A UC 95％CI of secondary sepsis were diagnosed and predicted by means of drainage fluid sTREM-1 and were 78.24％,83.57％,77.91 ug/L,0.85 (closest to 1.0) and 0.795-0.917,respectively.The analysis of ROC curve showed that the AUC of the ROC of secondary sepsis of multiple abdominal injuries diagnosed by means of drainage fluid sTREM-1 was much greater than that of serum sTREM-1,CRP and PCT and the difference had statistical significance (P ＜ 0.05).The analysis also showed that drainage fluid sTREM-1 had the most significant effects in the prediction of secondary abdominal sepsis.Conclusion Both drainage fluid and serum sTREM-1 can be used for the early prediction of secondary sepsis of multiple abdominal injuries,but the clinical predictive value of drainage fluid sTREM-1 is higher.