可溶性髓样细胞触发受体-1水平在呼吸机相关性肺炎监测中的意义

目的 观察血浆中可溶性髓样细胞触发受体-1（sTREM-1）对呼吸机相关性肺炎（VAP）早期诊断的意义.方法 2009年10月至2012年9月在深圳市第四人民医院ICU住院患者中,15例VAP患者为VAP组,14例接受机械通气但无VAP的患者为非VAP组,分别测定两组患者的血浆sTREM-1、PCT、IL-6浓度,应用受试者工作特征曲线（ROC）分析诊断的敏感度与特异度.结果 VAP组血浆sTREM-1水平均显著高于非VAP组[（0.835±0.7）ng/L：（0.388±0.1877） ng/L,P＜0.05]；而PCT[（1.723±0.421）ng/L：（1.771±0.343） ng/L]、Ⅱ-6[（1.51±0.362） ng/L：（1.508±0.333） ng/L]差异无统计学意义.血浆sTREM-1水平诊断呼吸机相关性肺炎的ROC曲线下面积为0.071,以0.864 ng/L为诊断浓度阈值,sTREM-1诊断VAP的敏感性为33.3％,特异性为100％.PCT的面积为0.505和IL-6 ROC曲线下面积为0.51.结论 血浆sTREM-1可作为VAP患者早期诊断的参考指标,诊断价值优于血浆PCT和IL-6.

Significance of soluble triggering receptor expressed on myeloid cells-1 in ventilator associated pneumonia.

Objective To describe the early diagnostic value of soluble triggering receptor expressed on myeloid cells-1 （sTREM-1） concentrations in ventilator associated pneumonia （VAP）. Methods The plasma levels of sTREM-1, PCT, IL-6 were examined in 15 patients with VAP （VAP group） and 14 patients undergoing ventilation without VAP （non-VAP group） in the Forth People＇s Hospital of Shenzhen from October 20109 to September 2013. By the Receiver Operating Characteristic （ROC） analysis, the sensitivity and specificity of each parameter were calculat- ed. Results In VAP group, sTREM-1 level in plasma was significantly higher than that in non-VAP group [（0.835± 0.7） ng/L vs （0.388±0.1877） ng/L, P〈0.05]. The levels of PCT [（1.723±0.421） ng/L vs （1.771±0.343） ng/L] or IL-6 [（1.51±0.362） ng/L vs （1.508±0.333） ng/L] in VAP group were significantly lower than those in non-VAP group. However, no other significant differences were observed among the two groups. By ROC analysis, the areas under ROC curve of sTREM-1 were 0.71. The cut-off value of sTREM-1 in plasma was 0.864 ng/L, with sensitivity and specificity of 33.3% and 100%, respectively. The area under ROC curve of PCT was 0.51, and that of IL-6 was 0.501. Conclusion sTREM-1 may be a useful marker in the early diagnosis of ventilator associated pneumonia. The diagnostic value of sTREM-1 may be superior to PCT and IL-6.