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目的:研究可溶性髓细胞表达触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)在慢性阻塞性肺病急性加重(AECOPD)患者治疗时指导抗菌药物使用的临床意义。方法:选取2007年8月～2009年2月246例AE-COPD患者,随机分配为常规治疗组(123例)和sTREM-1指导组(123例),入院后分别在d1用双抗体夹心ELISA法检测血清sTREM-1水平。在相同常规治疗基础上,常规治疗组患者由经治医师按照抗菌药物使用指南决定抗菌药物治疗方案,sTREM-1指导组患者按照血清sTREM-1水平决定是否使用抗菌药物,在血清sTREM-1≥20 ng/ml时,进行抗菌药物治疗,sTREM-1<20ng/mL且C反应蛋白(CRP)<5 mg/L时,不予抗菌药物治疗。观察两组患者的住院时间、临床有效率、住院费用、抗菌药物费用、住院病死率、1年随访期间AECOPD发生率及住院率。结果:两组患者在临床有效率、住院病死率、住院时间、1年随访期间AECOPD发生率及住院率方面差异无统计学意义(P分别为0.621、0.734、0.571、0.793和0.883),sTREM-1指导治疗组的抗菌药物费用及住院费用均低于常规治疗组(P分别为0.000和0.026)。结论:AECOPD患者入院之初进行sTREM-1水平检测可以作为指导抗菌药物使用的参考指标,有利于降低抗菌药物使用费用和总住院费用。
Objective: To investigate the clinical significance of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in guiding the use of antimicrobial agents in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A total of 246 patients with AE-COPD from August 2007 to February 2009 were randomly assigned to conventional therapy (123 cases) and sTREM-1 guidance group (123 cases). After admission, Method to detect serum sTREM-1 levels. On the basis of the same conventional treatment, the patients in the conventional treatment group were treated by the physician in accordance with the guidelines for the use of antimicrobial drugs to determine the antimicrobial treatment regimen. The patients in the sTREM-1 group were given antimicrobial agents according to the serum sTREM-1 level, Antibiotics were not given at 20 ng / ml, with sTREM-1 <20 ng / mL and C-reactive protein (CRP) <5 mg / L. The length of hospital stay, clinical efficacy, hospitalization costs, antimicrobial costs, hospital mortality, AECOPD incidence and hospitalization rate during 1-year follow-up were observed. Results: There was no significant difference in the incidence of AECOPD and hospitalization between the two groups (P> 0.621,0.734,0.571,0.793, and 0.883 respectively), clinical morbidity, in-hospital mortality, length of stay, and 1-year follow- The cost of antimicrobial drugs and hospitalization in 1-guided treatment group were lower than those in the conventional treatment group (P = 0.000 and 0.026, respectively). Conclusion: The detection of sTREM-1 in the early stage of admission of AECOPD patients can be used as a reference index to guide the use of antimicrobial agents, which will help to reduce the cost of antimicrobial drugs and the total cost of hospitalization.