9可溶性髓样细胞触发受体1在脓毒症中的表达和临床意义

目的探讨血清可溶性髓样细胞触发受体1（sTREM-1）在脓毒症中的表达和临床应用价值。方法采用ELISA检测68例脓毒症患者、40例非感染全身炎症反应综合征（SIRS）患者和20例正常对照血清sTREM-1、降钙素原（PCT）、肿瘤坏死因子α（TNF-α）和白细9胞介素10（IL-10）水平,免疫比浊法检测血清高敏C反应蛋白（hsCRP）水平,分析比较sTREM-1、PCT和hsCRP对脓毒症的诊断和预后判断价值。序贯器官衰竭估计（SOFA）评分系统评价脓毒症患者的严重程度,对sTREM-1、PCT和hsCRP与SOFA评分、TNF-α和IL-10之间分别进行相关分析。结果各组血清sTREM-1、PCT、hsCRP、IL-10水平和IL-10/TNF-α比值比较差异均有统计学意义（P〈0.05）;各组血清TNF-α水平比较差异无统计学意义（P〉0.05）。脓毒症组sTREM-1、PCT及hsCRP水平较非感染SIRS组显著升高（P〈0.05）。根据ROC曲线分析,sTREM-1、PCT和hsCRP对脓毒症及非感染SIRS进行诊断的曲线下面积（AUC）分别为0.772（95%CI 0.674～0.871）、0.718（95%CI 0.601～0.835）和0.664（95%CI 0.532～0.797）。脓毒症患者中死亡组sTREM-1和PCT水平较存活组显著升高（P〈0.01）,hsCRP水平与存活组间差异无统计学意义（P〉0.05）。脓毒症患者sTREM-1水平与SOFA评分、血清IL-10和IL-10/TNF-α比值呈明显正相关（r值分别为0.453、0.301和0.417,P均〈0.05）;与血清TNF-α无明显相关性（P〉0.05）。PCT与SOFA评分呈明显正相关（r=0.436,P〈0.05）;hsCRP与SOFA评分无明显相关性（P〉0.05）。结论血清sTREM-1水平不但有助于脓毒症的诊断,而且在一定程度上能作为判断疾病严重程度及预后的指标。sTREM-1和PCT可能在脓毒症诊断、预后判断和病情评估方面优于hsCRP。

Expression of Soluble Triggering Receptor Expression on Myeloid Cells-1 in Sepsis Patients and Its Clinical Implication

Objective To investigate the expression and clinical significance of soluble triggering receptor expression on myeloid cells-1（sTREM-1） in sepsis patients.Methods Serum concentrations of sTREM-1,procalcitonin（PCT）,tumor necrosis factor alpha（TNF-α） and interleukin-10（IL-10） were measured by enzyme-linked immunosorbent assay,while high sensitivity C-reactive protein（hsCRP） level was detected by immunoturbidimetry in 68 patients with sepsis,40 patients with no-infective SIRS,and 20 normal individuals.The diagnostic and prognostic value of sTREM-1 and its comparison with PCT and hsCRP were analyzed.The sequential organ failure assessment（SOFA） score system was used to evaluate the severity of sepsis.The relationship between sTREM-1,PCT,hsCRP ,SOFA score,TNF-α,and IL-10 of the sepsis patients was analyzed,respectively.Results The differences in the serum concentrations of sTREM-1,PCT,hsCRP,IL-10 and IL-10/TNF-α ratio had statistical significance among three groups（P0.05）.The differences in the serum concentration of TNF-α had no statistical significance among three groups（P0.05）.However,the serum levels of sTREM-1,PCT and hsCRP in the sepsis group were significantly higher than those in the SIRS group（P0.05）.The receiver operating characteristic curve（ROC） analysis showed the area under the curve（AUC） for sTREM-1,PCT and hsCRP were 0.772（95%CI 0.674-0.871）,0.718（95%CI 0.601-0.835） and 0.664（95%CI 0.532-0.797）,respectively.The serum levels of sTREM-1 and PCT in the non-survivors were significantly higher than the survivors in the sepsis group（P0.01）,but the differences in the serum concentration of hsCRP had no statistical significance between the non-survivors and the survivors in the sepsis group（P0.05）.There were significantly positive correlations between sTREM-1 and SOFA score,IL-10 or IL-10/TNF-α ratio（r value of 0.453,0.301,0.417,P0.05）,but no correlation between sTREM-1 and TNF-α（P0.05）.There was significantly positive correlation between PCT and SOFA score（r=0.436,P0.05）,while no relationship between hsCRP and SOFA score（P0.05）.Conclusions The serum level of sTREM1 not only be valuable in the diagnosis of sepsis,but also may be used as a prognostic marker in sepsis,as it can reflect the severity of sepsis in certain degree.Furthermore,sTREM-1 or PCT may be superior to hsCRP in diagnosis,prognostic judgment and severity assessment of sepsis.