可溶性髓样细胞触发受体-1对脓毒血症早期诊断价值

目的探讨可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)对脓毒血症的早期诊断价值。方法 81例全身炎症反应综合征患者,根据脓毒血症诊断标准分为脓毒血症组35例与SIRS组46例,选择体检健康者30名为对照组,检测3组血清sTREM-1、降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)水平。结果脓毒血症组与SIRS组患者血清sTREM-1,PCT及CRP水平均高于对照组(P<0.05);脓毒血症组血清sTREM-1与PCT水平高于SIRS组(P<0.05),CRP水平与SIRS组比较差异无统计学意义(P>0.05)。结论血清sTREM-1是脓毒血症早期诊断的辅助指标,其灵敏度和特异性高于PCT和CRP。     

可溶性髓样细胞触发受体-1对脓毒血症早期诊断价值的研究

目的探讨血清可溶性髓样细胞触发受体-1(sTREM-1)对脓毒血症的早期诊断价值。方法选择2010年7月至2013年6月该院急诊重症病房重症监护病房收治的81例患者,其中61例全身炎症反应综合征(SIRS)患者,根据脓毒血症诊断标准分为脓毒血症组39例与SIRS组22例,非SIRS患者20例作为对照组,检测3组血清sTREM-1和降钙素原(PCT)水平。结果脓毒血症组与SIRS组血清sTREM-1及PCT水平均明显高于对照组(P0.01);脓毒血症组血清sTREM-1及PCT水平均明显高于SIRS组(P0.01);sTREM-1和PCT在SIRS患者中早期诊断脓毒血症的受试者工作特征曲线下面积分别为0.932和0.670,sTREM-1的灵敏度和特异度分别为92.3%和86.4%,PCT的灵敏度和特异度分别为61.5%和81.8%。结论血清sTREM-1是脓毒血症早期诊断的较好指标,同时具有较高的灵敏度和特异度,优于PCT。     

血浆可溶性髓样细胞触发受体-1诊断脓毒症价值的Meta分析

目的 研究血浆可溶性髓样细胞触发受体-1在脓毒症诊断中的价值.方法 检索PubMed、Ovid、Springer数据库、万方数据库中1991年到2012年国内外公开发表的关于血浆可溶性髓样细胞触发受体-1诊断脓毒症的相关文献,根据纳入和排除标准筛选文献并提取可用数据,通过Meta-DiSc及Stata软件进行Meta分析.结果 根据纳入标准筛选出7篇文献,各个研究截断值差异较大.异质性检验表明资料存在异质性(I2＞50％,P ＜0.05),采用随机模型合并诊断指标.合并后的灵敏度81％,95％ CI:0.76～0.86;特异度81％,95％ CI:0.76 ～0.86;诊断优势比30.03,95％CI:7.89 ～ 114.37,SROC曲线的曲线下面积为0.905 9,Q*指数为0.837 6.Deek漏斗图显示无明显发表偏倚.结论 血浆可溶性髓样细胞触发受体-1用于脓毒症诊断具有一定的临床价值,但诊断脓毒症的最佳截断值有待进一步研究.     

可溶性髓样细胞触发受体－1在感染性疾病中的变化研究进展

髓样细胞触发受体－1是新近发现的细胞膜受体,选择性地表达于中性粒细胞、成熟单核．巨噬细胞等髓样细胞表面,在炎症反应中发挥主导作用。其通过特殊的细胞信号转导途径促进促炎介质的产生、抑制抗炎介质的表达而激活和放大炎症级联反应。其释放的亚型可溶性髓样细胞触发受体－1在众多感染性疾病中均升高,能够反映感染的严重程度。     

可溶性髓细胞触发受体-1在脓毒症诊断及病情判断的价值

目的 通过检测人血浆可溶性髓细胞触发受体-1(sTREM-1)水平,研究sTREM-1对脓毒症的诊断价值和在评估脓毒症严重程度及预后的意义.方法 将2010-05～2011-01收治的64例系统性炎症反应综合征(SIRS)患者,根据脓毒症诊断标准分为脓毒症组43例(脓毒症17例、严重脓毒症14例和脓毒性休克12例)、SIRS组(非感染)21例,根据28 d预后将脓毒症组分为存活组29例和死亡组14例.收集所有患者第1天的血浆,追踪留取脓毒症患者第1、4、7天的血浆,并记录对应时间的心率、白细胞计数、C反应蛋白(CRP)等临床数据.结果.患者入ICU第1天脓毒症组sTREM-1高于SIRS组[(147.28±58.32 pg/mL]比(81.61±24.57 pg/mL,P<0.05)];sTREM-1的受试者特征操作曲线下面积高于降钙素原(PCT)、CRP、IPS评分;sTREM-1水平变化与APACHEⅡ评分变化呈正相关(rs=0.446,P=0.000).sTREM-1水平在存活组则呈逐渐下降趋势,在死亡组随时间推移无明显变化趋势,死亡组sTREM-1于病程第4天起高于存活组同期对应指标(P＜0.05).结论.检测血浆sTREM-1可作为脓毒症早期诊断的指标,在诊断上具有良好的敏感性和特异性,诊断价值优于PCT、CRP及IPS评分等指标;动态监测检测血浆sTREM-1能反映疾病的严重程度及预后.     

可溶性髓系细胞触发受体-1对腹部创伤并发脓毒症的诊断价值

目的 探讨腹部创伤患者腹腔引流液可溶性髓系细胞触发受体-1(sTREM-1)的表达及其对腹部创伤后脓毒症的诊断价值.方法 将本院ICU收治的65例腹部创伤患者作为病例组,18例胃大部切除术(择期手术)后患者作为对照组,分别检测两组患者入ICU后0、24、48、72 h腹腔引流液sTREM-1、血清sTREM-1、前降钙素(PCT)和C反应蛋白(CRP)浓度,评价上述指标对创伤后脓毒症的早期诊断价值.结果 创伤组腹腔引流液sTREM-1、血清sTREM-1、PCT和CRP浓度明显高于对照组(P<0.05).创伤组中并发脓毒症组腹腔引流液sTREM-1、血清sTREM-1、PCT和CRP浓度明显高于未并发脓毒症组(P<0.05),腹腔引流液sTREM-1诊断创伤后脓毒症的敏感性82.5%,特异性84.0%,ROC曲线下面积0.885,明显优于血清sTREM-1、PCT及CRP(P<0.05).结论 腹腔引流液sTREM-1对腹部创伤后脓毒症的早期诊断有重要价值.     

血浆可溶性髓样细胞触发受体-1对脓毒症早期诊断的价值及预后意义

目的 探讨血浆可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)对脓毒症早期诊断的价值及预后意义。方法 采用前瞻性病例对照研究。将2009年5月至2010年6月天津医科大学第二医院重症监护病房( ICU)收治的56例系统性炎症反应综合征(SIRS)患者,根据2001年国际脓毒症会议诊断标准分为脓毒症组32例、SIRS组24例,同时收集非SIRS患者25例作为对照组,根据28 d转归将脓毒症组分为生存组和死亡组两个亚组。入院24h内测定血常规、血气分析、血生化、降钙素原（PCT）、C反应蛋白(CRP),记录最高体温(T),进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;采用酶联免疫吸附法(ELISA)检测sTREM-1水平。采用SPSS 16.0统计分析软件进行数据处理,计量资料采用方差或Kruskal-Wallis H检验,相关性分析采用Spearman相关系数。结果 血浆sTREM-1水平脓毒症组高于SIRS组及对照组[分别为250.9 (195.8 ～ 354.3) ng/L、103.6(89.4～166.2)ng/L、33.6 (26.2 ～43.0) ng/L,P＜0.01],死亡组高于生存组[分别为360.5 (262.2 ～434.5)ng/L、204.1（175.0～269.6）ng/L,P＜0.01];脓毒症组患者血浆sTREM-1水平与APACHEⅡ评分呈正相关(r,=0.426,P=0.032);sTREM-1 ROC曲线下面积为0.935,高于PCT、CRP。结论 血浆sTREM-1水平对脓毒症早期诊断有一定意义,早期sTREM-1水平升高与不良预后相关。     

乌司他丁对脓毒症患者可溶性髓样细胞触发受体-1表达的影响

目的:探讨乌司他丁对脓毒症患者可溶性髓样细胞触发受体-1 (sTREM-1)表达的影响.方法:选择60例确诊脓毒症的患者随机分为乌司他丁治疗组和常规治疗对照组,各30例.乌司他丁治疗组在常规治疗的基础上,加用乌司他丁20万单位/次静脉注射,2次/日连续10 d,分别于治疗前,治疗前第3、7和10日时取两组患者静脉血,采用ELISA法检测血清sTREM-1浓度,采用免疫比浊法检测CRP浓度.观察两组患者APACHEⅢ评分变化,并记录治疗后3、7、10和28 d时两组患者生存或死亡情况.检测30例健康志愿者的血清sTREM-1和CRP浓度作为正常对照组.结果:治疗前两组血清sTREM-1和CRP浓度显著高于健康对照组 (P＜0.05),但两组患者血清sTREM-1和CRP浓度比较差异无统计学意义(P＞0.05).治疗3、7、10 d两组血清sTREM-1和CRP浓度较治疗前逐步下降(P＜0.05).乌司他丁治疗组较常规治疗对照组血清sTREM-I和CRP浓度下降更显著(P＜0.05).APACHEⅢ评分降低更明显(P＜0.05).结论:乌司他丁可降低脓毒症患者血清sTREM-1和CRP水平,减轻脓毒症炎症反应强度,减少MODS的发生,从而缓解脓毒症临床症状,改善预后.     

血浆可溶性髓样细胞触发受体1对成人脓毒症患者诊断价值的Meta分析

目的评价血浆可溶性髓样细胞触发受体1（sTREM-1）对成人脓毒症患者的诊断价值。 方法检索PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库和中文科技期刊全文库（VIP）数据库从建库至2017年5月发表的有关血浆sTREM-1对成人脓毒症患者诊断价值的文献。采用双变量模型计算合并诊断比值比（DOR）、合并敏感度、合并特异度、合并阳性似然比（PLR）及合并阴性似然比（NLR）。进行合并受试者工作特征（SROC）曲线，获得曲线下面积（AUC）。 结果最终纳入30篇文献，共3 349例患者。Meta分析显示，合并DOR为20.03[95%置信区间（CI）（12.20，32.87）]、合并敏感度为0.82[95% CI（0.77，0.86）]、合并特异度为0.81 [95% CI（0.76，0.85）]、合并PLR为4.36 [95% CI（3.37，5.64）]、合并NLR为0.22[95%CI（0.16，0.29）]。SROC曲线显示合并AUC为0.89[95%CI（0.85，0.91）]。 结论血浆sTREM-1对诊断成人脓毒症患者具有中度诊断价值。     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

可溶性髓系细胞触发受体-1对呼吸机相关肺炎早期诊断及预后的判断价值

目的探讨血清及呼出气冷凝液（EVC）中可溶性髓系细胞触发受体-1（sTREM1）对呼吸机相关性肺炎（VAP）早期诊断及预后判断的临床价值。方法对37例机械通气患者进行治疗后评估,分成非感染组13例,感染组24例（其中治疗有效组14例,治疗无效组10例）,所有患者均在机械通气后第1、3、5、7天应用双抗体夹心酶联免疫吸附法（DAS-ELISA）测定血清和EVC中sTREM-1水平,并记录下呼吸道分泌物细菌培养结果和患者治疗后转归;应用受试者工作特征曲线（ROC）研究sTREM-1对VAP早期诊断效能及预后判断价值。结果第1天,血清及EVC中sTREM-1水平治疗有效组、治疗无效组及非感染组比较,差异无统计学意义（P〉0．05）;第3天和第5天,感染组较非感染组有明显升高（P〈（J．01）;第7天,治疗无效组仍处较高水平,与治疗有效组、非感染组比较差异有统计学意义（P〈0．01）,而治疗有效组与非感染组比较差异无统计学意义（P〉0．05）。应用ROC分析,第3天血清和EVC中sTREM-1曲线下面积分别为0．897、0．909。以第3天EVC中sTREM-14．70ng／mL为VAP的早期诊断界值,其诊断灵敏度为95．8％,特异度为92．3％。结论血清和EVC中sTREM-1检测有助于VAP的早期诊断,第7天血清和EVC中sTREM-1水平有助于判断VAP的预后（撤机失败和死亡）,与血清标本比较,EVC的获得更加方便。     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

目的 观察脓毒症患者血浆可溶性髓系细胞表达的触发受体-1(sTREM-1)动态变化,探讨其与感染相关器官功能衰竭评分系统(SOFA)评分对预后的评价.方法 采用前瞻性随机对照研究.选择2009年5月至2010年6月天津医科大学第二医院重症监护病房(ICU)收治的32例脓毒症患者,根据28 d转归分为生存组(21例)和死亡组(11例),检测患者入院后1、3、7 d的血小板计数(PLT),并进行SOFA评分;采用酶联免疫吸附法(ELISA)检测血浆sTREM-1浓度.以同期25例健康体检者作为对照.结果 对照组PLT为(248.88±48.62)×109/L,sTREM-1为25.7(21.5,53.3)ng/L.脓毒症死亡组PLT(×109/L)1 d时即明显下降,且随病情进展呈下降趋势(1、3、7 d分别为95.77±47.42、91.92±35.78、82.31±31.04),SOFA评分(分)亦随之下降(1、3、7 d分别为12.36±4.30、10.90±5.32、7.87±4.60),sTREM-1(ng/L)1 d时即明显升高,且随病程进展呈上升趋势[1、3、7 d分别为360.5(262.2,434.5)、373.5(263.1,495.6)、496.6(380.0,571.8)3;生存组PLT(×109/L)3 d时降低后有所升高(1、3、7 d分别为152.94±85.59、136.18±75.30、165.41±61.36),SOFA评分(分)则逐渐下降(1、3、7 d分别为6.76±2.71、4.29±2.31、2.52±1.03),sTREM-1(ng/L)峰值出现在1 d时,然后随病程进展逐渐下降[1、3、7 d分别为204.1(175.0,269.6)、164.0(145.9,194.2)、81.5(62.1,109.0)].与生存组比较,死亡组各时间点PLT明显下降,SOFA评分、sTREM-1明显升高(P＜0.05或P＜0.01).血浆sTREM-1水平与PLT呈显著负相关(r=-0.257,P=0.042),与SOFA评分呈显著正相关(r=0.736,P=0.002).结论 脓毒症患者sTREM-1水平在发病早期即明显升高,其动态变化联合SOFA评分可能更有助于判断预后.

Abstract：

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

脓毒症患者血清可溶性髓系细胞表达的触发受体-1水平及与预后的关系

Objective To approach the relationship between the contents of soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) and prognosis in patients with sepsis. Methods Using prospective, control study design, a total of 50 patients with sepsis who were admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University from March to December in the year of 2009 were enrolled. Firstly, the patients were divided into sepsis (n=28) and severe sepsis (n=22) groups according to the patients' condition. Then the patients were divided into survival group (n = 34) and death group (n = 16)according to the clinical outcome at 28 days after onset of sepsis. Clinical and laboratory data including blood routine tests, blood chemistry, blood gas analysis, C-reactive protein (CRP) and procalcitonin (PCT) were collected on the 1st, 3rd and 7th day after onset. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ ) score was determined. sTREM-1 levels were determined using enzyme linked immunosorbent assay (ELISA) method. Correlation analysis of the sTREM-1, APACHE I score, white blood cell count (WBC) and CRP, using Logistic regression analysis. A total of 30 healthy persons were enrolled into the control group. Results The sTREM-1 levels (ng/L) in 50 septic patients on the 1st day were higher than those of the healthy persons (52. 80±9. 30 vs. 23. 29±6. 22, P＜0. 01). The sTREM-1 levels (ng/L) in severe sepsis group on the 1st, 3rd and 7th day (58. 25±10. 59, 65. 75±13. 57, 50.18±21. 73) were higher than those of the sepsis group (48.55±5.20, 42.85±8.54, 34.02±12.86, P＜0.05 or P＜0.01). The sTREM-1 levels (ng/L) of the survival group on the 1st, 3rd and 7th day (53. 07± 10. 47, 45. 04±9. 89,32. 84 ±8. 42) were decreased with the progression of the ailment. The sTREM-1 levels did not differ significantly between the control group and survival group on the 7th day (P＞0. 05). The sTREM-1 levels (ng/L) in the death group on the 1st, 3rd and 7th day were increased with the progression of the ailment (52.27±6.42, 69.67±12.83, 75. 70± 10. 55), and the level was significantly higher than that in survival group on the 3rd and 7th day (both P＜0. 01). The contents of sTREM-1 were positive correlated with APACHE Ⅱ score (r= 0.657, P＜0. 01), but not correlated with WBC (r= 0.023, P＞0. 05), whilesomewhat correlated with CRP (r=0. 150, P＜0.10). Logistic regression analysis showed that sTREM-1 [odds ratio (OR) = 0. 893,P = 0. 000] and APACHE I score (OR = 0.771, P = 0.000) might be potential prognostic factors for septic patients. The area under the receiver operator characteristic curve was 0. 868 and 0.930. The sensitivity of prognostic evaluation was 81.1% and specificity was 74.5% with sTREM-1 50 ng/L, and the sensitivity was 83. 8% and specificity was 86. 3% with APACHE Ⅱ score 20 to estimate the outcome. Conclusion The serum sTREM-1 are elevated at early stage in sepsis patients. It can reflect the severity of the condition. The sTREM-1 level, which might be considered as a potential prognostic factor for septic patients, is significantly correlated with APACHE Ⅱ score.     

可溶性髓细胞触发受体-1对伴肺部渗出脓毒症患者的临床价值

目的检测新入ICU患者血清和肺泡灌洗液可溶性髓细胞触发受体-1（sTREM-1）,探讨sTREM-1在伴肺部渗出的脓毒症（ sepsis ）患者中的变化及意义。方法选择我院ICU 2012-09～2013-09收治的伴有肺部渗出及全身炎症反应综合征（ SIRS）的机械通气患者70例作为试验组,根据其临床特点及病原学检测结果,分为脓毒症组39例,非感染性SIRS组31例。两组在入院的第1、4、7天和第1、4天分别收集血清和肺泡灌洗液（ BALF）标本,同期纳入血清对照组30例,BALF对照组35例。采用酶联免疫吸附试验（ELISA）测定sTREM-1质量浓度,比较不同部位sTREM-1质量浓度与同期检测各种生物标志物对脓毒症的诊断及预后判断参数。结果①入院第1天脓毒症组血清sTREM-1质量浓度[425.20（653．72）pg/mL],与血清对照组（84.33±24．03）pg/mL及SIRS组[99．74（67．54）pg/mL]比较差异均有统计学意义（P＜0．01）;②入院第1天区分脓毒症与SIRS诊断的各参数ROC曲线下面积（ AUC）依次为血清sTREM-1（0．796）、CRP（0．668）,而入院第4天两组比较仅血清 sTREM -1差异有统计学意义（P ＝0.001）,其AUC为0．837;③各时间点脓毒症死亡组血清sTREM-1质量浓度均显著高于生存组（P＜0．05）,其中入院第1天判断脓毒症组预后各参数AUC依次为血清sTREM-1（0．792）、SOFA评分（0．756）;入院第4天依次为 SOFA 评分（0．801）、APACHEⅡ评分（0．757）、血清sTREM-1（0．696）;入院第7天依次为APACHEⅡ评分（0．835）、血清sTREM-1（0．725）;④入院第1、4及7天脓毒症生存组肺泡灌洗液sTREM-1质量浓度分别为（99．22±129．94,204．67±147．42,169．51±157．04）pg/mL,差异有统计学意义（P＝0．001）,而脓毒症死亡组不同时间点间比较差异无统计学意义（P＞0．05）。结论血清sTREM-1在伴有肺部渗出的脓毒症患者中呈高表达,显著高于SIRS患者及健康人群,其在脓毒症早期具有优于其他标志物的诊断与判断预后的能力,且肺泡灌洗液sTREM-1在病程后期下降,提示预后良好。     

血清可溶性髓系细胞触发受体-1检测在细菌性肺炎诊断中的意义

目的:检测细菌性肺炎患者外周血可溶性髓系细胞触发受体-1(sTREM-1)的水平,观察sTREM-1对诊断细菌性肺炎的意义。方法:应用双抗体夹心酶联免疫吸附法(ELISA)检测75例细菌性肺炎患者及72例正常健康体检者血清sTREM-1、降钙素原(PCT)、C反应蛋白(CRP)的水平。应用受试者工作特征(ROC)曲线研究sTREM-1的诊断效力。对肺炎组进一步进行亚组分析,并将sTREM-1水平与临床肺部感染评分(CPIS)进行相关性分析。结果:细菌性肺炎患者血清sTREM-1水平为(9.89±6.13)ng/mL,较对照组[(3.37±1.67)ng/mL]显著升高(P=0.001)。根据ROC曲线,sTREM-1取>4.46ng/mL为临界值,其曲线下面积为0.811,诊断细菌性肺炎的灵敏度为70.7%,特异度为76.4%,阳性预测值为75.7%,阴性预测值为71.4%,准确率为73.5%,诊断效能中等。肺炎组中重症肺炎患者血清sTREM-1为(12.65±6.37)ng/mL,较非重症患者[(9.14±5.91)ng/mL]水平增高,差异有统计学意义(P<0.05)。肺炎组患者sTREM-1水平与CPIS评分呈正相关(P<0.05)。结论:测定细菌性肺炎患者血清sTREM-1水平对于细菌性肺炎的诊断有一定价值。重症肺炎患者血清sTREM-1水平升高,且与CPIS评分相关,提示sTREM-1与感染严重程度相关。     

血必净对危重病患者可溶性髓系细胞表达触发受体1及炎症因子表达的影响

目的 探讨血必净注射液对危重病患者可溶性髓系细胞表达的触发受体1(sTREM-1)及炎症因子表达的影响.方法　将入住我院重症加强治疗病房(ICU)的危重病患者92例随机分为常规治疗组44例和与血必净治疗组48例,在相同的常规治疗基础上,血必净治疗组给予血必净注射液100 ml静脉滴注,每日2次,连续使用7天.两组患者治疗前及治疗后7天,分别抽血检测sTREM-1、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)的水平,记录全身炎症反应综合征(SIRS)、多器官功能障碍综合征(MODS)发生的情况及预后.结果 血必净治疗组能明显降低危重病患者体内sTREM-1、TNF-α、IL-6、IL-6/IL-10水平,治疗后sTREM-1和IL-6明显低于常规治疗组(49.17±30.42)ng/L vs(70.24±36.17)ng/L;(20.41±21.72)ng/L vs (54.91±21.02) ng/L( P＜0.01),MODS发生率、28天病死率明显下降(P＜0.05).结论 血必净注射液能有效改善患者预后,降低脏器功能不全的发生率,其机制可能与降低体内sTREM-1的水平、减轻全身炎症反应有关.     

胸腔积液可溶性髓系细胞触发受体1水平及意义

目的 探讨各种病因所致胸腔积液可溶性髓系细胞触发受体1(sTREM-1)的水平及意义.方法 分别收集细菌性胸腔积液(n=12)、结核性胸腔积液(n=31)、恶性肿瘤胸腔积液(n=35)和漏出液(n=15)患者的胸水和外周血标本,采用酶联免疫吸附测定法检测胸水和血清中sTREM-1的浓度.结果 4种类型的胸腔积液其胸水sTREM-1浓度均高于血清sTREM-l浓度(P＜0.05或＜0.01).细菌性胸腔积液其胸水和血清sTREM-l浓度均明显高于结核性胸腔积液、恶性肿瘤胸腔积液和漏出液,胸水sTREM-1[M(QR)]2 616.9(2 096.8)ng/L vs 286.0(348.0)ng/L、496.8(1 160.5)ng/L、102.3(266.5)ng/L(P＜0.01),血清sTREM-1 38.1(28.1)ng/L vs 0.2(19.8)ng/L、0.0(14.3)ng/L、15.7(67.6)ng/L(P＜0.01).结论 胸膜疾病胸腔积液TREM-1表达水平增高,以胸膜细菌感染时增高最明显,胸水sTREM-1浓度可以作为判断细菌感染的参考指标.