可溶性Toll样受体2联合PCT检测对血流感染致脓毒症诊断价值分析

目的探讨可溶性Toll样受体2(sTLR-2)联合降钙素原(PCT)检测对血流感染致脓毒症诊断价值。方法选取2019年3月—2021年3月西安交通大学第二附属医院收治的112例血流感染致脓毒症患者为研究对象,统计血流感染致脓毒症患者病原菌分布情况;分析影响血流感染致脓毒症患者病原菌感染特征的因素;分析sTLR-2联合PCT检测对血流感染致脓毒症患者的诊断价值。结果112例血流感染致脓毒症患者中有81例(72.32%)感染革兰阴性菌,有31例(27.68%)感染革兰阳性菌。Logistic回归多因素分析显示PCT(OR:4.035,95%CI:1.660~9.806)、sTLR-2(OR:3.904,95%CI:1.606~9.488)是影响血流感染致脓毒症患者病原菌感染类型的独立因素(P<0.05)。ROC曲线显示PCT、sTLR-2及二者联合诊断革兰阴性菌血流感染所致脓毒症的AUC分别为0.755、0.753、0.885(95%CI分别为:0.655~0.856,0.642~0.864,0.800~0.949)。结论革兰阴性菌血流感染致脓毒症发生风险高,PCT、sTLR-2与血流感染致脓毒症患者病原菌感染类型有关,二者联合预测革兰阴性菌血流感染所致脓毒症具有较高效能。

Diagnostic value of soluble Toll-like receptor 2 combined with procalcitonin in diagnosis of sepsis caused by bloodstream infection

Objective To explore the clinical value of soluble Toll-like receptor 2(sTLR-2)combined with procalcitonin(PCT)in the diagnosis of sepsis caused by bloodstream infection.Methods Peripheral venous blood samples were collected from 112 adult patients with sepsis caused by bloodstream infection at admission.Relative clinical data were collected.Quantitative immunoassay analyzer was used to test the serum level of PCT.The serum level of sTLR-2 was measured by Elisa.Automated blood culture system was used to culture pathogenic microorganisms.SPSS 19.0 soft-ware was adopted to conduct statistical analysis.Results 81 of the 112 cases(72.32%)were found to be infected with gram-negative bacteria,and 31 cases(27.68%)were infected with gram-positive bacteria.The APACHEⅡscore,SOFA score,and levels of endotoxin,C-reactive protein,CD8T lymphocyte,PCT,and sTLR-2 of the Gram-negative bacteria infection group were all significantly higher than those of the Gram-positive bacteriainfection group(all P<0.05);and the CD4 T lymphocyte level of the Gram negativebacteria infection group was significantly lower than that of the Gram-positive bacteriainfection group(P<0.05).Logistic regression multivariate analysis showed that PCT(OR:4.035,95%CI:1.660~9.806)and sTLR-2(OR:3.904,95%CI:1.606~9.488)were both independent influencing factors of infection type of sepsis.The ROC curve showed diagnostic capabilities for Gram-negative bacteria bloodstream infection of PCT,sTLR-2 and their combination as with the AUC levels 0.755,0.753,and 0.885 respectively(95%CI:0.655~0.856,0.642~0.864,0.800~0.949).Conclusion Simple and fast,testing PCT and sTLR-2 can be regarded as one high efficient method to diagnose sepsis caused by bloodstream infection.