血清可溶性髓细胞表达触发受体1在社区获得性肺炎患儿中的表达及临床意义

目的 探讨可溶性髓细胞表达触发受体1(soluble triggering receptor expressed on myeloid cells,sTREM-1)在儿科社区获得性肺炎中的检测及临床价值。方法 选取60例患有肺炎的住院患儿(细菌性肺炎31例,非细菌性肺炎患儿29例),以健康同龄人作为对照组。检测外周血中sTREM-1、血清前降钙素(PCT)、C反应蛋白(CRP)及白细胞计数(WBC)的表达水平;检测比较细菌性肺炎患儿治疗前后sTREM-1、PCT、CRP水平及变化规律;检测重症及非重症肺炎患儿sTREM-1、PCT、CRP水平。结果 1)细菌性肺炎组血sTREM-1水平(36.36±8.88)μg/L高于非细菌性肺炎组(16.86±1.83)μg/L及健康对照组(16.27±1.97)μg/L(P＜0.05),而非细菌性肺炎组sTREM-1与健康对照组差异无统计学意义(P＞0.05)。2)重症肺炎患儿血sTREM-1(61.18±13.72)μg/L高于非重症肺炎组(33.97±9.21)μg/L;非重症肺炎组(33.97±9.21)μg/L高于健康对照组(16.27±1.97)μg/L,差异均有统计学意义(P＜0.05)。3)细菌性肺炎组血PCT、CRP、WBC高于非细菌性肺炎组及健康对照组(P＜0.05),重症肺炎组高于非重症肺炎组(P＜0.05)。4)细菌性肺炎组患儿治疗前后sTREM-1水平呈连续进行性下降(36.36±8.88)μg/L vs.(27.34±6.48)μg/L,(16.38±4.20)μg/L,治疗后接近于正常儿童水平,差异有统计学意义(P＜0.05)。而PCT、CRP有所降低,早期下降程度不明显(第3天vs第1天),差异无统计学意义(P＞0.05)。结论 sTREM-1是早期鉴别诊断细菌感染性肺炎的重要指标,对指导抗生素的合理使用及病情评估、疗效判断有重要临床参考价值。

Detection and clinical significance of sTREM-1 in paediatrics community-acquired pneumonia.

Objective To discuss the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in identifying pediatric community-acquired pneumonia(CAP). Methods 60 cases of hospitalized children with pneumonia were selected(including 31 cases of bacterial pneumonia and 29 cases of non bacterial pneumonia),healthy children were recruited as controls.The serum level of sTREM-1,procalcitonin (PCT),C-reactive protein (CRP) and white blood cell count (WBC) count were detected and the changes of sTREM-1,PCT and CRP before and after the treatment in children with bacterial pneumonia were compared.The levels of sTREM-1,PCT,CRP were compared between severe pneumonia and non severe pneumonia. Results 1)sTREM-1 level in plasma of bacterial pneumonia group was higher than that in non-bacterial pneumonia group and normal control group [(36.36±8.88)μg/L vs.(16.86±1.83)μg/L,(16.27±1.97)μg/L (P<0.05)].There was no statistical significance between non-bacterial pneumonia group and normal control group (P>0.05).2)sTREM-1 level in plasma of severe pneumonia group was higher than that in non-severe pneumonia group [(61.18±13.72)μg/L vs.(33.97±9.21)μg/L(P<0.05)],sTREM-1 level in plasma of non-severe pneumonia group was higher than that in normal control group [(33.97±9.21)μg/L vs.(16.27±1.97)μg/L (P<0.05)].3) The levels of PCT,CRP and WBC in plasma of bacterial pneumonia group were higher than those in non-bacterial pneumonia group and normal control group (P<0.05);the levels of PCT,CRP and WBC in plasma of severe pneumonia group were higher than those in non-severe pneumonia group (P<0.05).4) After treatment,the level of sTREM-1 showed a continuous decline in bacterial pneumonia group [(36.36±8.88)μg/L vs (27.34±6.48)μg/L,(16.38±4.20)μg/L],the difference was significant (P<0.05).But the early decline in PCT and CRP were not obvious (third days vs.first days),there were no significant difference (P>0.05). Conclusion sTREM-1 is an important index in earlier period identification of bacterial pneumonia,it is of great meaning to guide the rational use of antibiotics,assess the condition and judge the curative effect.