血清可溶性髓细胞表达触发受体-1对社区获得性肺炎的诊断意义

Meaning of soluble triggering receptor expressed on myeloid cells-1 in diagnosis of community acquired pneumonia

关键词:  可溶性髓细胞表达触发受体-1  社区获得性肺炎  诊断  病情评估

Key words:  soluble triggering receptor expressed on myeloid cells-1  community acquired pneumonia  diagnosis  pathogenetic condition assessment

摘要:

目的　评价血清可溶性髓细胞表达触发受体-1(sTREM-1)对社区获得性肺炎(CAP)的诊断意义。　方法　选择CAP患者60例为肺炎组，24例健康成人为对照组。根据美国感染病学会/美国胸科协会重症CAP标准、CURB-65评分、PSI评分对病情严重程度评估。入院24 h内抽取肘静脉血，检测血清sTREM-1、CRP、Fbg及D-二聚体含量。 　结果　肺炎组患者血清sTREM-1、CRP、Fbg及D-二聚体水平均高于对照组（P<0.05）。重度肺炎组血清sTREM-1水平为（120.21±39.24）ng/L，轻中度肺炎组血清sTREM-1水平为（54.48±9.87）ng/L。重度肺炎组血清Fbg、sTREM-1水平与轻中度肺炎组比较差异有显著性意义（P<0.05），两组血清CRP、D-二聚体水平比较差异无显著性意义（P>0.05）。中高危肺炎组血清sTREM-1水平为（126.06±21.23）ng/L，低危肺炎组为（39.45±8.08）ng/L。中高危肺炎组血清Fbg、sTREM-1水平高于低危肺炎组，差异有显著性意义（P<0.05），两组血清CRP、D-二聚体水平比较差异无显著性意义（P>0.05）。在重症肺炎组血清sTREM-1水平为（122.34±24.14）ng/L，高于非重症肺炎组（44.74±9.22）ng/L。重症肺炎组血清Fbg、D-二聚体水平高于非重症肺炎组（P<0.05），两组血清CRP水平比较差异无显著性意义（P>0.05）。应用ROC曲线研究各生物指标诊断价值，结果显示sTREM-1的诊断效能最强（AUC为0.847），其次为CRP（AUC为0.753）、Fbg（AUC为0.675）及D-二聚体（AUC为0.668）。当血清sTREM-1水平＞15.79 ng/L时，诊断肺炎的敏感度为63.30%，特异度为83.30%，准确率为71.40%。 　结论　血清sTREM-1水平在CAP患者中明显升高,对CAP的诊断提供重要参考，其水平高低能够反映CAP的严重程度及预后情况。

Abstract:

Objective　To investigate the meaning of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the diagnosis of community acquired pneumonia (CAP).　Methods　Serum sTREM-1, CRP, Fbg, D-Dimer were determined in sixty patients with community acquired pneumonia and twenty-four healthy volunteers controls. CAP group patients were divided into non-severe pneumonia group (44 cases) and severe pneumonia group (16 cases) by IDSA/ATS severe CAP criteria, divided into mild & mid range pneumonia group (50 cases) and grossly pneumonia group (10 cases) by CURB-65 criteria, divided into low risk pneumonia group (42 cases) and high risk pneumonia group (18 cases) by PSI score.　Results　Level of serum sTREM-1 was significant higher in pneumonia group than in the normal control group. Level of serum CRP, Fbg, D-Dimer were higher in pneumonia group than in the normal control group, too. Level of serum sTREM-1 was higher in severe pneumonia group than in non-severe pneumonia group [(122.34±24.14) ng/L vs (44.74±9.22) ng/L，P<0.05]. Level of serum sTREM-1 was higher in grossly pneumonia group than in mild & midrange pneumonia group [(120.21±39.24) ng/L vs (54.48±9.87) ng/L, P<0.05]. Level of serum sTREM-1 was higher in high risk pneumonia group than in low risk pneumonia group [(126.06±21.23) ng/L vs (39.45±8.08) ng/L, P<0.05]. For ROC curve in diagnosis of CAP, when the cut-off value of sTREM-1 was set at ＞15.79 ng/L, the sensitivity was 63.30%, specificity was 83.30%, accuracy was 71.40%. 　Conclusion　Serum sTREM-1 level is higher in CAP. Detection of serum sTREM-1 is helpful in the diagnosis of CAP. Serum sTREM-1 level could help to evaluate the severity of infection.