摘要
目的研究可溶性髓样细胞触发受体-1(sTREM-1)对呼吸机相关性肺炎(VAP)诊断中的临床价值。方法患者共分4组:25例入住ICU临床疑诊VAP患者,根据肺泡灌洗液(BALF)细菌定量培养结果分为VAP确诊组(A组)14例,机械通气对照组(B组)11例,另有肺纤维化患者对照组(C组)10例,正常对照组(D组)18例。各组入选后在纤维支气管镜引导下行支气管肺泡灌洗术,收集肺泡灌洗液(BALF)标本、血清标本,分别测定各组肺泡灌洗液和血清中sTREM-1因子含量,并测定A、B组外周血白细胞(WBC)、C反应蛋白(CRP)、红细胞沉降率(ESR),记录A、B组临床肺部感染评分(CPIS)。结果①A组患者BALF中sTREM-1水平显著高于B组、C组及D组(P均<0.05);但A组血清中sTREM-1浓度与B组、D组相比差异无统计学意义(P均>0.05)。②A组患者BALF中sTREM-1和其他指标的诊断效率由曲线下面积(ROC)测定,结果示当取阈值为143.83 ng/L时,BALF中sTREM-1产生诊断敏感性为92.9%,特异性为81.8%。结论机械通气患者肺泡灌洗液(BALF)中sTREM-1的高表达,可作为临床VAP的早期诊断的生物标记物,同时有助于VAP与肺部非感染性疾病的鉴别诊断。
Objective To investigate the clinical value of soluble triggering receptor Expressed on Myeloid Cell-1（sTREM-1） in ventilator-associated pneumonia and to provide experimental research principle for early clinical diagnosis of VAP.Methods Patients were divided into four groups.In the ICU,25 patients with suspected ventilator-associated pneumonia（VAP） were selected,14 cases of them being confirmed as VAP diagnosed group（Group A）,the other 11 cases as mechanical ventilation control group（Group B） according to the results of bacterial cultures.The other two control groups included 28 cases,10 patients with pulmonary fibrosis（Group C） and 18 healthy cases（Group D）.Every case was given the protective lung lavage guided by fiberoptic bronchoscope when they were selected and collected fluid samples and corresponding serum samples.ELASA method was used to measured titre of sTREM-1 in BALF and serum of experimental group and control groups.WBC,ESR and CRP in serum were measured and the clinical pulmonary infection scores（CPIS） were recorded in group A and group B.Results ①sTREM-1 titre in BALF of group A increased significantly compared with those of group B,group C or group D（all P〈0.05）.sTREM-1 titre in serum of group A compared with those of group B or group D was no significant difference（all P〉0.05）.②The areas under receiver operating characteristic（ROC） curve of sTREM-1 and other factors in BALF of group A were measured.The results suggested that sTREM-1 was the strongest indicator of VAP.While taken a cut-off value of 143.83 ng/L,its diagnostic sensitivity was 92.9% and specificity was 81.8%.Conclusion sTREM-1 assay in BALF may be regarded as a better marker in both the early diagnosis of VAP and the reliable differentiation from non-infectious pulmonary infiltrates in ventilated patients.
出处
《中华全科医学》
2012年第1期5-6,8,F0003,共4页
Chinese Journal of General Practice
基金
2008年安徽省高校青年教师自然科学资助项目(2008jq1108)
