摘要
目的:观察联合检测可溶性髓样细胞触发受体-1(sTREM-1),内皮细胞特异性分子-1(ESM-1)和降钙素原(PCT)在脓毒症早期诊断和预后临床价值。方法:选择2015年1月至2017年12月在我院ICU收治的脓毒症患者136例,为脓毒症组。选择同期在ICU治疗全身炎症反应综合征(SIRS)未发展为脓毒症的患者56例和健康体检者30例,分别为非脓毒症组和对照组。比较脓毒症组,非脓毒症组和对照组血清sTREM-1,ESM-1和PCT水平差异,采用方差分析比较不同严重程度脓毒症患者血清各指标水平差异,采用Spearman相关性分析比较各指标之间的相关性,应用Logistic回归和受试者曲线评价联合sTREM-1,ESM-1和PCT检测在诊断脓毒症和预测预后的效能。结果:脓毒症组的血清sTREM-1,ESM-1和PCT水平明显高于非脓毒症组和对照组(P<0.01),而非脓毒症组水平明显高于对照组(P<0.01)。脓毒症患者血清sTREM-1,ESM-1和PCT水平随着脓毒症严重程度的增加而升高(P<0.01)。死亡组的血清sTREM-1,ESM-1和PCT水平明显存活组(P<0.01)。脓毒症患者血清sTREM-1水平与ESM-1(r=0.684,P<0.01)和PCT(r=0.716,P<0.01)水平呈正相关,同样ESM-1水平和PCT水平呈正相关(r=0.754,P<0.01)。在预测诊断脓毒症方面,联合检测的曲线下面积0.957,灵敏度为82.4%和特异性为98.2%明显优于sTREM-1(Z=4.840,P<0.01),ESM-1(Z=4.350,P<0.01)和PCT(Z=4.554,P<0.01),而sTREM-1,ESM-1和PCT的曲线下面积之间的比较差异无统计学意义(P>0.05)。在预测预后方面,联合检测的曲线下面积0.969,灵敏度为95.8%和特异性为96.9%明显优于sTREM-1(Z=3.923,P<0.01),ESM-1(Z=4.487,P<0.01)和PCT(Z=2.617,P<0.01),而sTREM-1,ESM-1和PCT的曲线下面积之间的比较差异无统计学意义(P>0.05)。结论:sTREM-1,ESM-1和PCT参与了脓毒症疾病的发生发展过程,联合检测明显优于单个指标检测,对于早期诊断和预测预后具有重要临床价值。
Objective:To observe the combined detection of soluble myeloid trigger receptor-1(sTREM-1),endothelial cell-specific molecule-1(ESM-1)and procalcitonin(PCT)in the early diagnosis and prognosis in patient with sepsis.Methods:136 patients with sepsis in ICU,from January 2015 to December 2017,were selected as sepsis group.In the same period,56 patients with systemic inflammatory response syndrome(SIRS)who had not developed sepsis in the ICU and 30 healthy people were selected as non-sepsis group and control group.The differences of serum sTREM-1,ESM-1 and PCT levels were compared among sepsis group,non-sepsis group and control group.The analysis of variance was used to compare the serum levels in sepsis patients with different severity.The Spearman correlation analysis was used to compare the indicators.Logistic regression and receiver operating characteristic curve of sTREM-1,ESM-1 and PCT were used to value the efficacy in diagnosing sepsis and predicting prognosis.Results:The serum levels of sTREM-1,ESM-1,and PCT in the sepsis group were significantly higher than those in the non-sepsis group and the control group(P<0.01),whereas levels in the non-sepsis group were significantly higher than those in the control group(P<0.01).The serum sTREM-1,ESM-1,and PCT levels increased in sepsis patients with the severity of sepsis(P<0.01).The serum levels of sTREM-1,ESM-1 and PCT in the death group were significantly higher than those in the survivor group(P<0.01).The serum levels of sTREM-1 in sepsis patients were positively correlated with ESM-1(r=0.684,P<0.01)and PCT(r=0.716,P<0.01),and the positive correlation between ESM-1 and PCT levels(r=0.754,P<0.01).In the predictive diagnosis of sepsis,the area under the curve of the combined detection was 0.957,the sensitivity was 82.4%,and the specificity was 98.2%.It was significantly better than sTREM-1(Z=4.840,P<0.01),and ESM-1(Z=4.350,P<0.01)and PCT(Z=4.554,P<0.01),but there was no significant difference in the area under the curve among sTREM-1,ESM-1 and PCT(P>0.05).In predi
作者
谢鸣峰
XIE Mingfeng(Shanghai Tongji Hospital,Shanghai 200065,China)
出处
《河北医学》
CAS
2019年第9期1451-1455,共5页
Hebei Medicine
