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目的:探讨支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)及呼出气冷凝液(exhaled breath condensate,EBC)中的可溶性髓系细胞触发受体-1(soluble triggering receptor expressed on myeloid cells 1,sTREM-1)含量,以及其在呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)诊断中的价值。方法:纳入2014年3所教学医院中疑似VAP的患者127例,于疑诊VAP当日及诊断VAP当日行纤维支气管镜肺泡灌洗,并检测BALF及EBC中s TREM-1的含量,经受试者工作特征(receiver operating characteristic,ROC)曲线选取最佳临界值,评估其诊断效价。结果:127例疑似VAP的患者中72例(56.69%)被诊断为VAP。于诊断当日检测VAP及非VAP患者BALF中的s TREM-1含量为58.06 pg/m L[四分位数间距(interquartile range,IOR)为40.45~70.71 pg/m L]和16.69 pg/m L(IOR为13.24~33.07 pg/m L),而两者EBC中的s TREM-1含量分别为1.97 pg/m L(IOR为1.54~2.61 pg/m L)和0.56 pg/m L(IOR为0.26~1.59 pg/m L),比较发现,VAP患者BALF及EBC中的s TREM-1含量均高于非VAP患者(P<0.05)。诊断当日检测BALF中s TREM-1含量的ROC曲线下面积为0.917,且具有良好的诊断灵敏度(87.51%)和特异度(81.82%),最佳临界值为37.11 pg/m L(P<0.001)。结论:BALF及EBC中的sTREM-1含量对于VAP的诊断准确率较高,值得临床推广。
Objective: To investigate the expression of soluble triggering receptor expressed on myeloid cells 1 (sTREM- 1) content, and its value in the diagnosis of ventilator-associated pneumonia (VAP). Methods: A total of 127 suspected VAP patients were enrolled in three teaching hospitals in 2014. The patients were treated with bronchofocalcoverage alveolar lavage on the day of VAP diagnosis and the day of VAP diagnosis. The levels of TREM-1 in BALF and EBC were detected. The receiver operating characteristic (ROC) curve was used to select the best cutoff value to evaluate its diagnostic potency. Results: 72 (56.69%) of 127 patients with suspected VAP were diagnosed with VAP. The s TREM-1 content in BALF was 58.06 pg / m L [interquartile range (IOR) was 40.45-70.71 pg / m L] and 16.69 pg / m L on both VAP and non-VAP patients on the day of diagnosis (IOR was 13.24 ~ 33.07 pg / m L), while the contents of s TREM-1 in EBC were 1.97 pg / m L (IOR 1.54 ~ 2.61 pg / m L) and 0.56 pg / m L 0.26 ~ 1.59 pg / m L). The levels of s-TREM-1 in BALF and EBC in VAP patients were higher than those in non-VAP patients (P <0.05). The area under the ROC curve of sTREM-1 in BALF measured on the day of diagnosis was 0.917 with good diagnostic sensitivity (87.51%) and specificity (81.82%), the optimal cut-off value was 37.11 pg / m L ). CONCLUSIONS: The sTREM-1 levels in BALF and EBC are of high diagnostic accuracy for VAP and are worthy of clinical application.