血清降钙素原、白细胞介素6、C反应蛋白在感染性疾病中的诊断价值

目的 探究血清降钙素原（PCT）、白细胞介素6（IL-6）和C反应蛋白（CRP）在感染性疾病诊断中的价值。方法 选择收集ICU病房感染性疾病113例患者血清,另收集36例健康体检者血清作为健康对照组。PCT的检测采用电化学发光法（ECLIA）;CRP检测应用免疫比浊法测定;IL-6应用酶联免疫吸附法（ELISA）测定。结果 细菌性感染组PCT阳性率显著高于病毒感染组（P〈0．05）,重症感染组阳性率高于轻症感染组（P〈0．05）;与健康对照组比较,细菌性感染组PCT、CRP与IL-6水平均升高,差异有统计学意义（P〈0．05）。3个指标比较,PCT和CRP的特异性高于IL-6,IL-6的敏感性高于PCT和CRP。结论 PCT作为感染性指标在疾病的诊断中具有临床价值,有助于细菌感染性与非细菌感染、轻症感染与重症感染的鉴别;PCT、CRP、IL-6三者联合测定能够更准确、灵敏地诊断感染性疾病。     

血清降钙素原、超敏C反应蛋白及白细胞介素-6在小儿急性上呼吸道感染中的诊断价值

目的探讨血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及白细胞介素-6(IL-6)在小儿急性上呼吸道感染中的诊断价值。方法选取该院收治的急性上呼吸道感染患儿136例作为观察组,并根据患儿实验室诊断结果,将观察组患儿分为细菌感染组与病毒感染组,同时选取同期83例健康儿童作为对照组。对比各组PCT、hs-CRP、IL-6水平,同时比较观察组治疗前后PCT、hs-CRP、IL-6水平,比较PCT、hs-CRP、IL-6的诊断价值。结果细菌感染组PCT、hs-CRP、IL-6水平明显高于对照组,差异有统计学意义(P0.05)。治疗后PCT、hs-CRP、IL-6水平明显低于治疗前,差异有统计学意义(P0.05)。PCR敏感度与特异度相对较高,且阳性与阴性预测率均明显高于其他两项,约登指数也有显著提高,差异有统计学意义(P0.05)。三项联合检测虽然敏感度有所提高,但特异度降低,约登指数下降。结论 PCT、hs-CRP、IL-6对于小儿急性上呼吸道感染均有一定的临床意义,PCT作为判断是否为细菌感染的指标特异度更好,真实度更高,对三项指标的联合检测及综合评价,可显著提高急性上呼吸道感染的敏感度,对于早期病情诊断与预后评估等均具有重要的临床意义。     

感染性肾结石围术期血清降钙素原、C反应蛋白、白细胞介素6变化的临床价值

对2013年2月~2014年2月我院收治的86例微创治疗感染性肾结石患者按术后全身的炎症反应(SIRS)发生情况,分为发生组27例和未发生组59例,观察对比两组围术期PCT、CRP、IL-6水平,以分析围术期PCT、CRP、IL-6检测对预测术后SIRS的临床价值。结果两组术后PCT、CRP、IL-6均较术前有不同程度升高,P<0.05;其中,SIRS发生组术后上述检测指标均明显高于未发生组,组间比较差异具有统计学意义,P<0.05。通过测定PCT、CRP、IL-6的水平,对早期评估感染性肾结石术后SIRS有重要的临床价值,临床可依据PCT、CRP、IL-6水平,有选择性地予以抗感染治疗,对改善临床预后有积极的临床意义。     

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。     

降钙素原与C反应蛋白及白细胞介素-6联合检测在慢性乙型肝炎中的临床意义

目的探讨降钙素原(PCT)、C反应蛋白(CRP)及白细胞介素-6(IL-6)在慢性乙型肝炎诊断和治疗中的意义。方法收集2013年5月至2014年3月接受治疗的慢性乙型肝炎患者60例,作为观察组;选取同期60例健康查体者作为对照组。检测其血清CRP、PCT及IL-6水平,分析这些指标在慢性乙型肝炎诊断和治疗中的意义。结果观察组CRP、PCT、IL-6水平分别为(10.7±6.8)mg/L、(11.2±6.1)μg/L、(253.2±45.1)ng/L,明显高于对照组的(3.3±1.0)mg/L、(1.2±0.5)μg/L、(64.5±10.1)ng/L,两组比较差异具有统计学意义(P0.05)。经ROC曲线分析,CRP敏感性为56.9%,特异性为70.6%;IL-6敏感性为92.3%,特异性为95.5%;PCT敏感性为67.5%,特异性为85.0%。结论 PCT、CRP及IL-6联合检测对慢性乙型肝炎的诊断及治疗具有非常重要的临床价值。     

白细胞介素-6、降钙素原、C反应蛋白、APACHE Ⅱ评分在ICU重症感染患者中的诊断价值

目的探讨白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分在ICU重症感染患者中的诊断价值。方法选取在ICU病房住院的130例患者作为研究对象,将76例重症感染患者设为研究组,另54例非感染患者设为对照组,比较2组患者的实验室指标结果。结果研究组患者的IL-6、PCT、CRP水平显著高于对照组患者(P 0. 05);研究组患者的APACHEⅡ评分结果与对照组相比,差异有统计学意义(P 0. 05)。结论血清IL-6、PCT、CRP在ICU重症感染患者的感染诊断中具有较好的灵敏度,上述指标联合APACHEⅡ评分在评估患者病情严重程度及感染程度方面具有较高的准确性。     

临床和实验室指标预测早发性卒中相关性肺炎的前瞻性研究

目的 评估入院当日首次血清降钙素原(PCT)、C-反应蛋白(CRP)、可溶性髓细胞表达受体1(sTREM-1)、临床肺部感染评分(CPIS)在预测早发性卒中相关性肺炎(EOP)中的作用.方法 采用前瞻性观察及诊断试验研究,纳入2009年6月至2010年6月上海市第五人民医院急诊重症监护病房(EICU)244例脑卒中患者;排除入院时明确诊断肺炎、24 h内出院或死亡者,入院当日测定患者血清PCT、CRP和sTREM-1,并计算CPIS评分.结果 244例脑卒中患者中105例诊断为EOP,其中74例为重症EOP.EOP组血清PCT、CRP、sTREM-1和CPIS评分显著高于非EOP组[PCT(μg/L):4.20(0.83,7.75)比0.19(0.12,0.41);CRP(mg/L):56.0(18.5,105.5)比9.0(7.0,15.0);sTREM-1(ng/L):56.0(24.5,111.5)比10.0(8.0,16.0);CRIS评分(分):4.0(2.5,4.0)比2.0(1.0,2.0),均P＜0.01];且重症EOP组血清PCT、CRP、sTREM-1和CPIS评分显著高于非重症EOP组[PCT(μg/L):6.10(3.40,8.83)比0.61(0.42,1.67);CRP(mg/L):80.5(31.5,113.0)比21.0(12.0,43.0); sTREM-1(ng/L):89.0(53.8,132.8)比21.0(14.0,43.0);CPIS评分(分):4.0(3.0,5.0)比2.0(2.0,3.0),均P＜0.01].预测EOP时,PCT＞0.43μg/L的敏感性和特异性为89.5%和79.1%,CRP＞16 mg/L的敏感性和特异性为78.1%和78.4%,sTREM-1＞19 ng/L的敏感性和特异性为81.9%和84.9%,CPIS评分＞2分的敏感性和特异性为75.2%和79.9%;以PCT＞0.43μg/L和CPIS评分＞3分联合预测EOP的敏感性和特异性可达到81.9%和92.1%.预测重症EOP时,PCT＞2.15μg/L的敏感性和特异性为87.8%和83.9%,CRP＞43 mg/L的敏感性和特异性为70.3%和77.4%,sTREM-1＞51 ng/L的敏感性和特异性为81.1%和90.3%,CPIS评分＞3分的敏感性和特异性为67.6%和83.9%;以PCT＞2.15μg/L和sTREM-1＞56 ng/L联合预测重症EOP的敏感性和特异性可达到82.4%和100.0%.结论 首次PCT是预测EOP的有效指标,首次CPIS评分可作为发生EOP的一种筛查手段,两者联合预测可以提高EOP预测的特异性.首次sTREM-1是预测卒中患者发展为重症EOP的有效指标,首次PCT联合sTREM-1可以显著提高预测重症EOP的特异性.

Abstract：

Objective To investigate the significance of first determined contents of procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) and the clinical pulmonary infection score (CPIS) in the detection of early-onset pneumonia (EOP) developed in patients suffering from stroke. Methods From June 2009 to June 2010, 244 stroke patients admitted to the emergency intensive care unit (EICU) in Shanghai Fifth People's Hospital were included in this prospective study. Patients were excluded if they were discharged or died in 24 hours of admission, or pneumonia was diagnosed at the admission. The serum levels of PCT, CRP and sTREM-1 were determined, and the CPIS was calculated in all patients on the day of admission. Results Among all 244 stroke patients, EOP was diagnosed in 105 of them, and 74 developed severe EOP. The serum levels of PCT, CRP, sTREM-1 and the CPIS in patients with EOP were significantly higher than those in patients who did not develop EOP [PCT (μg/L): 4.20 (0.83, 7.75) vs. 0.19 (0.12, 0.41); CRP (mg/L): 56.0 (18.5, 105.5) vs. 9.0(7.0, 15.0); sTREM-1 (ng/L): 56.0 (24.5, 111.5) vs. 10.0 (8.0, 16.0); CRIS: 4.0 (2.5, 4.0) vs. 2.0 (1.0, 2.0), all P＜0. 01], and the levels of PCT, CRP, sTREM-1 and the CPIS in patients with severe EOP were significantly higher than those in patients with mild EOP [PCT (μg/L): 6.10 (3.40, 8. 83) vs.0.61 (0.42, 1.67); CRP (mg/L): 80.5 (31.5, 113.0) vs. 21.0 (12.0, 43.0); sTREM-1 (ng/L): 89.0(53.8, 132.8) vs. 21.0 (14.0, 43.0); CPIS: 4.0 (3.0, 5.0) vs. 2.0 (2.0, 3.0), all P＜0. 01]. The cutoff point, sensitivity and specificity of each indicator to predict EOP were 89. 5% and 79. 1% in PCT＞0. 43 μg/L, 78. 1% and 78. 4% in CRP＞16 mg/L, 81.9% and 84. 9% in sTREM-1＞19 ng/L, 75. 2% and 79.9% in CPIS＞2. Using PCT＞0. 43 μg/L combined with CPIS＞3 to predict EOP, the sensitivity and specificity reached 81.9 % and 92. 1 % respectively. The cutoff point , sensitivity and specificity of indicators to identify severe EOP were 87. 8% and 83. 9% in PCT＞2.15μg/L, 70.3% and 77.4% in CRP＞43 mg/L,81.1% and 90.3% in sTREM-1＞51 ng/L, 67.6% and 83.9% in CPIS＞3. Using PCT＞2.15 μg/L combined with sTREM-1＞56 ng/L to predict severe EOP, the sensitivity and specificity reached 82. 4% and 100. 0% respectively. Conclusion The first PCT is an effective indicator to predict EOP. The first CPIS is an index for screening EOP. PCT combined with CPIS may improve the specificity to predict EOP. The first sTREM-1 is a good indicator to identify severe EOP. Combination of first PCT and sTREM-1 may greatly improve the specificity to predict severe EOP.     

白细胞介素‐6、降钙素原及 C‐反应蛋白在新生儿败血症早期诊断中的价值

目的探讨白细胞介素‐6(IL‐6)、降钙素原(PCT )和C‐反应蛋白(CRP)在新生儿败血症早期诊断中的价值.方法将179例受试对象分为败血症组(124例)和健康对照组(55例),比较两组血中IL‐6、PCT、CRP的差异.结果新生儿败血症组IL‐6、PCT和CRP水平明显高于健康对照组,治疗前明显高于恢复期( P<0.01).结论 IL‐6、PCT和CRP可作为新生儿败血症快速有效诊断和评估病情的检测指标.     

可溶性髓样细胞触发受体-1对严重多发伤患者继发感染早期诊断价值探讨

目的 探讨可溶性髓样细胞触发受体-1(sTREM-1)对严重多发伤患者继发感染的早期诊断价值.方法 测定57例损伤严重度评分不低于16分的多发伤患者血清sTREM-1、降钙素原(PCT)和C反应蛋白(CRP)含量,并与健康对照组进行比较,应用ROC曲线进行分析.结果 与健康对照组比较,多发伤未继发感染和继发感染患者血清sTREM-1、PCT和CRP水平升高(P＜0.05);继发感染组血清sTREM-1和PCT水平高于非感染组(P＜0.05),CRP水平比较差异无统计学意义(P＞0.05).sTREM-1、PCT和CRP的ROC曲线下面积分别为0.954,0.863和0.785;最佳阈值分别为8.79、8.16 ng/mL和69.47 mg/L,灵敏度分别为0.912、0.787和0.938,特异度分别为0.894、0.845和0.513.结论 血清sTREM-1是早期诊断严重多发伤患者继发感染的较好指标,其诊断效能优于PCT和CRP.     

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。     

小剂量激素对小儿脓毒症血清可溶性髓系细胞触发受体1、降钙素原、CD_(64)的影响

目的探讨小剂量糖皮质激素对小儿脓毒症血清可溶性髓系细胞触发受体1(s TREM-1)、降钙素原(PCT)、CD_(64)的影响。方法选取66例脓毒症患儿,依据随机数字表法分成2组各33例。对照组予原发病和(退热等)对症治疗,予以脓毒症集束化(抗生素、强化胰岛素、营养支持等)治疗,研究组在上述基础上再予小剂量注射用甲泼尼龙琥珀酸钠静点,治疗7 d。检测外周血T淋巴细胞、炎性指标(PCT、CRP、IL-8)和sTREM-1、sICAM-1及sVCAM-1水平。评估PCIS及APACHEⅡ评分,比较治疗效果。结果与治疗前比较,2组CD_3~+、CD_4~+及CD_8~+显著升高(P0.01),CD_(64)+降低(P0.01),PCT、CRP、IL-8显著降低(P0.01),sTREM-1、sICAM-1、sVCAM-1显著降低(P0.01),PCIS评分显著升高(P0.05),APACHEⅡ评分显著降低(P0.05);与对照组比较,研究组CD_3~+、CD_4~+及CD_8~+显著较高(P0.01),CD_(64)+显著较低(P0.01),PCT、CRP、IL-8显著较低(P0.01),sTREM-1、sICAM-1、sVCAM-1显著较低(P0.01),PCIS评分显著较高(P0.05),APACHEⅡ评分显著较低(P0.05),总有效率显著较高(P0.05)。结论小剂量糖皮质激素能有效降低脓毒症患儿血清sTREM-1、PCT、CD_(64)~+水平。     

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。     

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.     

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.     

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.     

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。     

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。