脓毒症患者血清中TLR-4、TREM-1、sCD14和IL-18的变化

目的探讨脓毒症患者血清TLR-4、TREM-1、sCD14和IL-18含量的变化与脓毒症严重程度的相关性及用于诊断脓毒症的敏感度与特异度。方法选取60例脓毒症患者及30例正常体检者,分别抽血采用酶联免疫法(ELISA法)测TLR-4、TREM-1、sCD14和IL-18的含量。脓毒症患者根据当天进行APACHE-Ⅱ评分结果,按评分≥20分和20分进入高评分及低评分脓毒症组。结果脓毒症患者上述各因子的含量治疗前均明显高于治疗后,并高于正常对照组(p值均0.05),并且与APACHE-Ⅱ评分呈正相关(r=0.651、0.662、0.652、0.668,P均0.05)。治疗前高评分脓毒症组血清中TLR-4、TREM-1、sCD14、IL-18的含量均明显高于低评分脓毒症组(P均0.05);脓毒症患者治疗前血清中上述细胞因子的ROC曲线下面积分别为1.000、0.795、0.828、0.834及0.850,APACHE-Ⅱ、TLR4、TREM-1及sCD-14分别取20、25.8 ng/ml、89.6 ng/ml及75 ng/ml为截断点,评价预后敏感性分别为为99%、82%、82%及91%,特异性分别为为100%、52%、66%及72%。结论脓毒症患者血清中TLR-4、TREM-1、sCD14、IL-18的含量与脓毒症的发生发展关系密切;通过监测上述细胞因子的含量可以对脓毒症病情严重程度做出一定的判断;TREM-1有可能成为诊断脓毒症较好的实验室指标之一,sCDl4有望成为较为敏感的脓毒症诊断标志物之一。

Changes of serum TLR-4, TREM-1, sCD14 and IL-18 in patients with sepsis

Objective To investigate the changes of TLR-4, TREM-1, sCD14 and IL-18 in serum of pa-tients with sepsis and their relationships to the diagnostic sensitivity and specificity of sepsis. Methods The study selected 60 patients with sepsis and 30 healthy people as the normal control group. The levels of TLR-4, TREM-1, sCD14 and IL-18 in venous blood were detected by enzyme-linked immunosorbent assay （ ELISA） . Results There were significant differences in the contents of TLR-4, TREM-1, sCD14 and IL-18 of patients with sepsis before and after the treatment, and they were obviously higher in the observation group than in the normal control group （ P〈0. 05）. The contents of TLR-4, TREM-1, sCD14 and IL-18 were all positively correlated with APACHE-Ⅱscore in patients with sepsis （r=0. 651, 0. 662, 0. 652 and 0. 668, （P〈0. 05）. The serum contents of TLR-4, TREM-1, sCD14 and IL-18 were significantly higher in high score of APACHE-Ⅱ group than in the low score group （ P 〈0. 05）. The area under ROC curve of the contents of TLR-4, TREM-1, sCD14 and IL-18 of sepsis patients before treatment were 1. 000, 0. 795, 0. 828, 0. 834 and 0. 850 respectively. Taking APACHE-Ⅱ and sCD-14, TLR4, TREM-1 of 20, 25. 8 ng/ml, 89. 6 ng/ml and 75 ng/ml as cut-off points, the sensitivity was 99%, 82%, 82% and 99% respectively, and the specificity was 100%, 52%, 66% and 100% respectively. Conclusion The contents of serum TLR-4, sCD14, IL-18 and TREM-1 in patients of sepsis are closely associated with the occurrence of sepsis development. We can make a judgment of severity of sepsis by monitoring the levels of cytokines above. TREM-1 may be one of the better indexes of diagnosis of sepsis. SCDl4 is expected to become one of the sensitive diagnostic mark-ers of sepsis.