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目的探讨血浆中可溶性髓样细胞触发受体-1(s TREM-1)对呼吸机相关性肺炎(VAP)诊断和病情评估的意义。方法测定15例VAP患者(VAP组)和14例接受机械通气但无VAP的患者(非VAP组)血浆s TREM-1、降钙素原(PCT)、白介素-6(IL-6)浓度,分析s TREM-1与PCT、IL-6、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性,应用受试者工作特征(ROC)曲线分析诊断的敏感度与特异度。结果 VAP组血浆s TREM-1水平明显高于非VAP组[(0.835±0.700)ng/L vs(0.388±0.188)ng/L,P<0.05],而两组间PCT[(1.723±0.421)ng/L vs(1.771±0.343)ng/L]和IL-6[(1.510±0.362)ng/L vs(1.508±0.333)ng/L]差异无统计学意义。VAP组s TREM-1与IL-6、APACHEⅡ评分呈显著相关性(r=0.521、0.663,P<0.05)。血浆s TREM-1诊断呼吸机相关性肺炎的ROC曲线下面积为0.71,以0.864 ng/L为诊断浓度阈值,s TREM-1诊断VAP的特异性为100.0%。结论血浆s TREM-1在VAP诊断中特异性高,对评估VAP疾病严重程度有重要意义。
Objective To investigate the significance of soluble TRP-1 in plasma on the diagnosis and assessment of ventilator-associated pneumonia (VAP). Methods Plasma s TREM-1, procalcitonin (PCT), interleukin-6 (IL-6) levels in 15 patients with VAP (VAP group) and 14 patients without mechanical ventilation (VAP group) The correlation between s TREM-1, PCT, IL-6, acute physiology and chronic health status Ⅱ (APACHEⅡ) was analyzed. The diagnostic sensitivity and specificity were analyzed by receiver operating characteristic (ROC) curve. Results The level of plasma s TREM-1 in VAP group was significantly higher than that in non-VAP group [(0.835 ± 0.700) ng / L vs (0.388 ± 0.188) ng / L, P <0.05] There was no significant difference between the two groups (ng / L vs 1.771 ± 0.343 ng / L) and IL-6 [(1.510 ± 0.362) ng / L vs (1.508 ± 0.333) ng / L] There was a significant correlation between TREM-1 and IL-6 and APACHEⅡscores in VAP group (r = 0.521,0.663, P <0.05). The area under the ROC curve of plasma s-TREM-1 in diagnosis of ventilator-associated pneumonia was 0.71. The specificity of s TREM-1 in diagnosing VAP at 0.864 ng / L was 100.0%. Conclusion The serum s TREM-1 is highly specific in the diagnosis of VAP. It is important to evaluate the severity of VAP.