余娇,梁显泉
YU Jiao,LIANG Xianquan

• 1:贵州医科大学
• 2:贵阳市妇幼保健院
• 3:贵州医科大学急诊教研室

摘要(Abstract)：

目的:检测人血浆可溶性髓样细胞触发受体-1(s TREM-1)、降钙素原(PCT)和肿瘤坏死因子-α(TNF-α)水平,评价s TREM-1对多发伤合并脓毒症的诊断价值。方法:69例多发伤患者,根据损伤严重度评分(ISS)分为严重创伤组及非严重创伤组,按脓毒症诊断标准分为脓毒症组及非脓毒症组,根据入院28 d治疗结局分为存活组和死亡组;收集所有患者入院1 h内的血浆,检测s TREM-1、PCT、TNF-α水平,分析s TREM-1、PCT及TNF-α与ISS评分的相关性,采用受试者工作特征曲线(ROC)分析血浆s TREM-1、PCT及TNF-α水平对多发伤合并脓毒血症早期诊断灵敏度和特异性。结果:严重创伤组s TREM-1、PCT及TNF-α均高于非严重创伤组(P<0.05),脓毒症组s TREM-1、PCT及TNF-α均高于非脓毒症组(P<0.05),血浆s TREM-1与ISS评分变化呈正相关(r=0.759,P=0.000);诊断创伤合并脓毒症的ROC曲线下面积依次为s TREM-l 0.819(95%CI 0.693~0.945)、PCT 0.756(95%CI 0.611~0.901)、TNF-α0.576(95%CI 0.407~0.746),差异有统计学意义(P<0.05);s TREM-l、PCT、TNF-α的敏感性分别为83.3%、72.2%、61.1%,特异性分别为77.8%、70.3%、63.0%;患者入院后1 h检测的s TREM-1水平,死亡组高于存活组(P<0.05)。结论:s TREM-1对多发伤后并发脓毒症的早期预测价值优于PCT、TNF-α。
Objective: To investigate soluble triggering receptor expressing on myeloid cells-1( s TREM-1),PCT,and TNF-α levels of patients,to investigate complicating sepsis and the efficacy of s TREM-1 in prognosis of multiple traumas. Methods: According to ISS scoring,69 patients were divided into the severe traumatic group and non-severe traumatic group. According to diagnostic criteria for sepsis,patients were divided into sepsis group and non-sepsis group. Moreover,according to 28-day prognosis results,further divided into the survival group and death group. Collecting plasma of all patients within 1 hour they were admitted to hospital and tested s TREM-1,PCT and TNF-α levels.Correlations of ISS score with STREM-1,PCT and TNF-α were analyzed respectively. The receiver operating characteristic( ROC) curve was used to figure out the sensitivity and specificity of s TREM-1,PCT and TNF-α levels in early diagnosis of multiple traumas,especially the complicate sepsis.Results: s TREM-1,PCT and TNF-α in the severe traumatic group were higher than the non-severe traumatic group,and differences had statistical significance( P < 0. 05). s TREM-1,PCT and TNF-αin the sepsis group were higher than the non-sepsis group,and differences had statistical significance( P < 0. 05). sT REM-1 in plasma showed a positive correlation with ISS,and the correlation coefficient( rs) was 0. 759,P = 0. 000. Areas under ROC curves for diagnosing complex sepsis were respectively0. 819( 95% CI 0. 693 ~ 0. 945) for sT REM,0. 756( 95% CI 0. 611 ~ 0. 901) for PCT and 0. 576( 95% CI 0. 407 ~ 0. 746) for TNF-α. All of the three indexes had statistical significance( P <0. 05). The sensitivity degrees of sT REM-l,PCT and TNF-α were respectively 83. 3%,72. 2% and61. 1%,and the specificity of sT REM-l,PCT and TNF-α were respectively 77. 8%,70. 3% and63. 0%. The sT REM-1 levels in plasma collected from patients in the death group 1 hour after they were admitted were higher than the survival group,and the difference between them had statistical significance( P < 0. 05). Conclusion: sT REM-1 had greater predictive values be used as early-warning indexes for the occurrence of complicated sepsis after multiple traumas.

关键词(KeyWords)： 脓毒症;降钙素原;肿瘤坏死因子α;可溶性髓系细胞触发受体-1;多发伤
sepsis;procalcitonin;tumor necrosis factor α;soluble triggering receptor-1;multiple traumas

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 余娇,梁显泉
YU Jiao,LIANG Xianquan

DOI: 10.19367/j.cnki.1000-2707.2016.08.022

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