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目的探讨机械通气对重症肺部感染患者的可溶性髓样细胞触发受体-1(soluble triggering receptorexpressed on myeloid cell-1,sTREM-1)及肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)影响及其临床价值。方法选取42例肺部感染并给予有创机械通气的住院患者,观察机械通气前及通气后第1、3、6、9、12天的临床指标变化;同时采用ELISA检测血sTREM-1、TNF-α、IL-6、IL-1β水平。另以健康同龄人作为对照组。结果肺部感染患者血中sTREM-1、TNF-α、IL-6、IL-1β均高于健康对照组(P<0.01),但上述指标在肺部感染患者之间差异无统计学意义(P>0.05)。肺部感染患者机械通气前后24 h sTREM-1差异无统计学意义(P>0.05),TNF-α、IL-6、IL-1β有所升高(P<0.05)。在预后不良者中临床指标好转不明显或有所恶化,且sTREM-1、TNF-α、IL-6、IL-1β有明显上升趋势(P<0.01);在预后良好者中临床指标明显好转,sTREM-1水平稳定或轻度下降,TNF-α、IL-6、IL-1β下降较明显(P<0.05)。结论肺部感染、机械通气可引起TNF-α、IL-6、IL-1β升高,但sTREM-1受肺部感染的影响,机械通气对其无影响。上述炎症介质水平对需机械通气的重症肺部感染患者有相对独立的预后评价意义。
Objective To investigate the effects of mechanical ventilation on soluble triggering receptorepressed on myeloid cell-1 (sTREM-1) and tumor necrosis factor-α (TNF-α), interleukin- 6 (IL-6), interleukin-1β (IL-1β) and its clinical value. Methods Forty-two patients with pulmonary infection were selected and inpatients with invasive mechanical ventilation were enrolled. The changes of clinical indexes on the 1st, 3rd, 6th, 9th and 12th days after mechanical ventilation were observed. Meanwhile, the levels of sTREM-1, TNF -α, IL-6, IL-1β levels. Another healthy peers as a control group. Results The serum levels of sTREM-1, TNF-α, IL-6 and IL-1β in patients with pulmonary infection were significantly higher than those in healthy controls (P <0.01), but there was no significant difference between the above indexes in patients with pulmonary infection P> 0.05). There was no significant difference in sTREM-1 levels between before and after mechanical ventilation in patients with lung infection (P> 0.05), and the levels of TNF-α, IL-6 and IL-1β were increased (P <0.05). The prognosis of patients with poor prognosis showed no significant improvement or worsened, and the sTREM-1, TNF-α, IL-6 and IL-1βwere significantly increased (P <0.01) , sTREM-1 level was stable or mildly decreased, TNF-α, IL-6, IL-1β decreased more significantly (P <0.05). Conclusions Pulmonary infection and mechanical ventilation can cause the increase of TNF-α, IL-6 and IL-1β. However, sTREM-1 is not affected by pulmonary infection. The above inflammatory mediators have a relatively independent prognostic significance in patients with severe pulmonary infection requiring mechanical ventilation.