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目的探讨血清可溶性髓样细胞触发受体1(sTREM-1)在脓毒症中的表达和临床应用价值。方法采用ELISA检测68例脓毒症患者、40例非感染全身炎症反应综合征(SIRS)患者和20例正常对照血清sTREM-1、降钙素原(PCT)、肿瘤坏死因子α(TNF-α)和白细胞介素10(IL-10)水平,免疫比浊法检测血清高敏C反应蛋白(hsCRP)水平,分析比较sTREM-1、PCT和hsCRP对脓毒症的诊断和预后判断价值。序贯器官衰竭估计(SOFA)评分系统评价脓毒症患者的严重程度,对sTREM-1、PCT和hsCRP与SOFA评分、TNF-α和IL-10之间分别进行相关分析。结果各组血清sTREM-1、PCT、hsCRP、IL-10水平和IL-10/TNF-α比值比较差异均有统计学意义(P<0.05);各组血清TNF-α水平比较差异无统计学意义(P>0.05)。脓毒症组sTREM-1、PCT及hsCRP水平较非感染SIRS组显著升高(P<0.05)。根据ROC曲线分析,sTREM-1、PCT和hsCRP对脓毒症及非感染SIRS进行诊断的曲线下面积(AUC)分别为0.772(95%CI 0.674～0.871)、0.718(95%CI 0.601～0.835)和0.664(95%CI 0.532～0.797)。脓毒症患者中死亡组sTREM-1和PCT水平较存活组显著升高(P<0.01),hsCRP水平与存活组间差异无统计学意义(P>0.05)。脓毒症患者sTREM-1水平与SOFA评分、血清IL-10和IL-10/TNF-α比值呈明显正相关(r值分别为0.453、0.301和0.417,P均<0.05);与血清TNF-α无明显相关性(P>0.05)。PCT与SOFA评分呈明显正相关(r=0.436,P<0.05);hsCRP与SOFA评分无明显相关性(P>0.05)。结论血清sTREM-1水平不但有助于脓毒症的诊断,而且在一定程度上能作为判断疾病严重程度及预后的指标。sTREM-1和PCT可能在脓毒症诊断、预后判断和病情评估方面优于hsCRP。
Objective To investigate the expression and clinical value of serum soluble myeloid cell-trigger receptor 1 (sTREM-1) in sepsis. Methods Serum levels of sTREM-1, procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) in 68 patients with sepsis, 40 patients with non-infected systemic inflammatory response syndrome (SIRS) and 20 normal controls were detected by ELISA. ) And interleukin-10 (IL-10) levels in serum and serum hsCRP levels were detected by immunonephelometry. The diagnostic and prognostic value of sTREM-1, PCT and hsCRP in sepsis were analyzed. Sequential organ failure assessment (SOFA) scoring system was used to evaluate the severity of sepsis and the correlation between sTREM-1, PCT, hsCRP, SOFA score, TNF-α and IL-10 was analyzed. Results The serum levels of sTREM-1, PCT, hsCRP, IL-10 and IL-10 / TNF-α were significantly different in all groups (P <0.05). There was no significant difference in serum TNF- Significance (P> 0.05). The levels of sTREM-1, PCT and hsCRP in sepsis group were significantly higher than those in non-infected SIRS group (P <0.05). According to the ROC curve analysis, the area under the curve (AUC) of sTREM-1, PCT and hsCRP for the diagnosis of sepsis and non-infected SIRS were 0.772 (95% CI 0.674-0.871), 0.718 (95% CI 0.601-0.835) And 0.664 (95% CI 0.532 ~ 0.797). The levels of sTREM-1 and PCT in the death group were significantly higher than those in the survivor group (P <0.01), while there was no significant difference between the survivals group and the hsCRP group (P> 0.05). The level of sTREM-1 in patients with sepsis was positively correlated with SOFA score, serum IL-10 and IL-10 / TNF-α (r = 0.453,0.301 and 0.417, respectively, P <0.05) α no significant correlation (P> 0.05). There was a significant positive correlation between PCT and SOFA scores (r = 0.436, P <0.05). There was no significant correlation between hsCRP and SOFA score (P> 0.05). Conclusion The serum level of sTREM-1 not only contributes to the diagnosis of sepsis, but also can be used as an index to judge the severity and prognosis of the disease. sTREM-1 and PCT may be superior to hsCRP in the diagnosis of sepsis, prognosis and disease assessment.