可溶性髓样细胞触发受体1在尿源性脓毒血症患者中的临床意义

目的  初步探讨可溶性髓样细胞触发受体1（sTREM-1）对泌尿外科腔镜手术后尿源性脓毒血症患者的早期诊断、预后评估价值。方法  回顾性分析2008年1月-2015年12月南方医科大学第五附属医院收治的74例泌尿外科腔镜手术后尿源性脓毒血症患者（观察组）的临床资料。随机同期选取74例未发生尿源性脓毒血症的手术患者作为对照组，分析两组患者血清C反应蛋白（CRP）、血清降钙素原（PCT）、sTREM-1和尿液sTREM-1浓度的变化。通过Person法分析sTREM-1与尿源性脓毒血症死亡患者生存时间的相关性，应用Cox比例风险模型分析与尿源性脓毒血症患者死亡相关的危险因素，ROC曲线下面积判断血清CRP、PCT、sTREM-1和尿液sTREM-1的诊断效能。结果  观察组在术后30 d内有22例死亡，病死率29.7%；观察患者组血清CRP、PCT浓度在术后1 d、3 d和7 d明显高于对照组，观察组患者血、尿sTREM-1浓度在术前、术后1 h、1 d、3 d和7 d明显高于对照组，差异有统计学意义（P <0.05）；血sTREM-1诊断敏感性和特异性高于CRP、PCT；血sTREM-1和尿sTREM-1浓度是影响尿源性脓毒血症患者的独立危险因素，与预后呈负相关。结论  血、尿sTREM-1的检测有助于泌尿外科腔镜手术后尿源性脓毒血症的早期诊断，血、尿sTREM-1的浓度水平是影响尿源性脓毒血症患者预后的独立危险因素。

Clinical significance of sTREM-1 for patients with urine-derived sepsis

Objective To evaluate the value of sTREM-1 in the early diagnosis and prognosis of patients with urosepsis after urologic endoscopy surgery. Methods One hundred and forty-eight patients, who were treated in Department of Urology, the Fifth Affiliated Hospital of Southern Medical University from January 2008 to December 2015, were divided into observation and control groups according to the infection status. Serum and urine levels of sTREM-1, and serum levels of PCT and CRP were analyzed retrospectively. Indicators including CRP, PCT and sTREM-1 were managed by receiver operating characteristic. The risk factors were analyzed by Cox proportional hazards analysis. The relevance between sTREM-1 and survival time of patients with urosepsis was analyzed by Person. Results Twenty-two patients died in the observation group, and the fatality rate was 29.7%. The serum levels of PCT and CRP increased at 1 d, 3 d and 7 d after the operation in the observation group, while the serum and urine levels of sTREM-1 increased at pre-operation, 1 h, 1 d, 3 d and 7 d. The sensitivity and specificity of sTREM-1 were higher than CRP, PCT. Serum and urine levels of sTREM-1 were independent risk factors for the prognosis of urosepsis, and were negative correlated with the prognosis. Conclusions The detections of serum and urine levels of sTREM-1 help the early diagnosis of urosepsis after urologic endoscopy surgery, and are independent risk factors for urosepsis.