血清PCT、CRP与sTREM-1在肺癌患者术后肺部感染中表达及其诊断价值分析

目的:探究血清降钙素原(PCT)、C-反应蛋白(CRP)与可溶性人髓系细胞触发受体-1(sTREM-1)在肺癌患者术后肺部感染中表达及其诊断价值。方法:选择2016年2月至2019年10月期间在我院行肺癌根治术的420例肺癌患者作为研究对象,根据术后患者是否发生肺部感染进一步划分为380例未感染组和40例感染组。感染组根据治疗结局进一步划分为29例治疗好转亚组与11例未好转亚组。采用酶联免疫吸附法检测各组的血清PCT、CRP与s TREM-1水平,采用受试者工作特征(ROC)曲线分析血清PCT、CRP和s TREM-1对肺癌患者术后肺部感染的预测价值。结果:与未感染组相比,感染组手术后血清PCT、CRP和s TREM-1水平均明显升高(P0.05)。与治疗好转亚组相比较,治疗未好转亚组手术后以及感染后血清PCT、CRP和s TREM-1水平均明显升高(P0.05)。ROC曲线显示,PCT的曲线下面积(AUC)为0.713,最佳截断值为1.23 ng/mL,灵敏度、特异度分别为0.81、0.79,准确度为0.82;CRP的AUC为0.752,最佳截断值为36.07 mg/L,灵敏度、特异度分别为0.83、0.81,准确度为0.83;s TREM-1的AUC为0.792,最佳截断值为20.58 pg/mL,灵敏度、特异度分别为0.86、0.84,准确度为0.85;PCT、CRP联合s TREM-1预测肺癌患者术后肺部感染的AUC为0.884,灵敏度、特异度分别为0.89、0.91,准确度为0.92。结论:肺癌根治术后肺部感染发生与患者血清PCT、CRP和s TREM-1水平相关,早期联合检测血清PCT、CRP和s TREM-1有助于预测肺癌根治术患者肺部感染发生风险,在肺癌根治术后肺部感染的预测和诊断中具有一定临床价值。     

Immune and endothelial activation markers and risk stratification of childhood pneumonia in Uganda: A secondary analysis of a prospective cohort study

BackgroundDespite the global burden of pneumonia, reliable triage tools to identify children in low-resource settings at risk of severe and fatal respiratory tract infection are lacking. This study assessed the ability of circulating host markers of immune and endothelial activation quantified at presentation, relative to currently used clinical measures of disease severity, to identify children with pneumonia who are at risk of death.Methods and findingsWe conducted a secondary analysis of a prospective cohort study of children aged 2 to 59 months presenting to the Jinja Regional Hospital in Jinja, Uganda between February 2012 and August 2013, who met the Integrated Management of Childhood Illness (IMCI) diagnostic criteria for pneumonia. Circulating plasma markers of immune (IL-6, IL-8, CXCL-10/IP-10, CHI3L1, sTNFR1, and sTREM-1) and endothelial (sVCAM-1, sICAM-1, Angpt-1, Angpt-2, and sFlt-1) activation measured at hospital presentation were compared to lactate, respiratory rate, oxygen saturation, procalcitonin (PCT), and C-reactive protein (CRP) with a primary outcome of predicting 48-hour mortality. Of 805 children with IMCI pneumonia, 616 had severe pneumonia. Compared to 10 other immune and endothelial activation markers, sTREM-1 levels at presentation had the best predictive accuracy in identifying 48-hour mortality for children with pneumonia (AUROC 0.885, 95% CI 0.841 to 0.928; p = 0.03 to p < 0.001) and severe pneumonia (AUROC 0.870, 95% CI 0.824 to 0.916; p = 0.04 to p < 0.001). sTREM-1 was more strongly associated with 48-hour mortality than lactate (AUROC 0.745, 95% CI 0.664 to 0.826; p < 0.001), respiratory rate (AUROC 0.615, 95% CI 0.528 to 0.702; p < 0.001), oxygen saturation (AUROC 0.685, 95% CI 0.594 to 0.776; p = 0.002), PCT (AUROC 0.650, 95% CI 0.566 to 0.734; p < 0.001), and CRP (AUROC 0.562, 95% CI 0.472 to 0.653; p < 0.001) in cases of pneumonia and severe pneumonia. The main limitation of this study was the unavailability of radiographic imaging.ConclusionsIn this cohort of Ugandan children, sTREM-1 measured at hospital presentation was a significantly better indicator of 48-hour mortality risk than other common approaches to risk stratify children with pneumonia. Measuring sTREM-1 at clinical presentation may improve the early triage, management, and outcome of children with pneumonia at risk of death.Trial registrationThe trial was registered at clinicaltrial.gov ({"type":"clinical-trial","attrs":{"text":"NCT 04726826","term_id":"NCT04726826"}}NCT 04726826).

Chloe R. McDonald and colleagues assess the ability of immune and endothelial activation markers to identify risk of death from pneumonia among children in Uganda.     

细菌性血流感染所致脓毒症患者血清PCT、APOM、sTREM-1与预后的关系研究

摘要 目的：探讨细菌性血流感染（BSI）所致脓毒症患者血清降钙素原（PCT）、载脂蛋白M（APOM）、可溶性髓系细胞触发受体-1（sTREM-1）与预后的关系。方法：选取2021年1月～2023年10月首都医科大学附属北京朝阳医院收治的细菌性BSI所致脓毒症患者185例（脓毒症组）,根据28d内预后情况分为死亡组（61例）和存活组（124例）,另选取同期体检健康志愿者87例（对照组）。采用电化学发光法检测血清PCT水平,酶联免疫吸附法检测血清APOM、sTREM-1水平。单因素及多因素Logistic回归模型分析影响细菌性BSI所致脓毒症患者预后的因素。受试者工作特征（ROC）曲线分析血清PCT、APOM、sTREM-1对细菌性BSI所致脓毒症患者预后的预测价值。结果：与对照组比较,脓毒症组血清PCT、sTREM-1水平升高,APOM水平降低（P＜0.05）。185例细菌性BSI所致脓毒症患者28d死亡死亡率为32.97%（61/185）。与存活组比较,死亡组血清PCT、sTREM-1水平升高,APOM水平降低（P＜0.05）。多因素分析结果显示：革兰阴性菌感染、脓毒性休克、中性粒细胞/淋巴细胞比值（NLR）升高、序贯器官衰竭评估（SOFA）评分增加、急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分增加、血清PCT升高和sTREM-1升高为细菌性BSI所致脓毒症患者死亡的独立危险因素,血清APOM升高为独立保护因素（P＜0.05）。血清PCT、APOM、sTREM-1联合检测预测细菌性BSI所致脓毒症患者死亡的曲线下面积为0.908,大于血清PCT、APOM、sTREM-1单独检测预测的0.785、0.779、0.783。结论：细菌性BSI所致脓毒症患者血清PCT、sTREM-1水平升高和APOM水平降低与预后不良的发生有关,血清PCT、APOM、sTREM-1联合检测对细菌性BSI所致脓毒症患者死亡有较高的预测价值。     

血清sTREM-1、肺功能指数与肺癌患者术后肺部感染的关系及其预测价值研究

目的:探讨血清髓样细胞触发受体-1(sTREM-1)、肺功能指数与肺癌患者术后肺部感染的关系及其预测价值。方法:回顾性分析2016年1月-2019年1月在我院进行手术治疗的115例肺癌患者的临床资料,根据患者术后72 h是否发生肺部感染将其分为感染组(n=28)及未感染组(n=87)。对比两组患者临床资料、术后6 h血清s TREM-1、降钙素原(PCT)水平及术前肺功能指数[第一秒用力呼气量(FEV1)、呼气流量峰值(PEF)]变化,记录感染组患者痰细菌培养结果,采用Logistic分析肺癌患者术后感染的影响因素,并采用受试者工作特征(ROC)曲线分析s TREM-1、FEV1、PEF在肺癌术后感染的预测价值。结果:感染组术后入住ICU比例大于未感染组,感染组TNM分期为IV期的比例大于未感染组(P0.05),感染组术后6 h血清s TREM-1、PCT水平高于未感染组,术前FEV1、PEF水平低于未感染组(P0.05)。感染组痰培养结果提示G-菌为17例,占60.71%;G+菌10例,占35.71%;真菌1例,占3.57%。二元多因素Logistic分析提示术后6 h血清s TREM-1水平升高、术前FEV1下降及PEF下降、术后入住ICU为肺癌患者术后感染的独立影响因素。三者联合预测曲线下面积为0.850(95%CI:1.350～1.745,P=0.000),敏感度与特异性分别为91.3%与80.6%,优于s TREM-1、FEV1、PEF的单独预测效能。结论:s TREM-1水平升高,术前FEV1、PEF水平降低与肺癌患者术后肺部感染密切相关,对s TREM-1、FEV1、PEF三者联合分析对于预测肺癌患者术后肺部感染的发生具有较高的预测价值。     

Clinical Usefulness of Procalcitonin and C-Reactive Protein as Outcome Predictors in Critically Ill Patients with Severe Sepsis and Septic Shock

Sepsis is a major cause of mortality and morbidity in critically ill patients. Procalcitonin (PCT) and C-reactive protein (CRP) are the most frequently used biomarkers in sepsis. We investigated changes in PCT and CRP concentrations in critically ill patients with sepsis to determine which biochemical marker better predicts outcome. We retrospectively analyzed 171 episodes in 157 patients with severe sepsis and septic shock who were admitted to the Samsung Medical Center intensive care unit from March 2013 to February 2014. The primary endpoint was patient outcome within 7 days from ICU admission (treatment failure). The secondary endpoint was 28-day mortality. Severe sepsis was observed in 42 (25%) episodes from 41 patients, and septic shock was observed in 129 (75%) episodes from 120 patients. Fifty-five (32%) episodes from 42 patients had clinically-documented infection, and 116 (68%) episodes from 99 patients had microbiologically-documented infection. Initial peak PCT and CRP levels were not associated with treatment failure and 28-day mortality. However, PCT clearance (PCTc) and CRP (CRPc) clearance were significantly associated with treatment failure (p = 0.027 and p = 0.030, respectively) and marginally significant with 28-day mortality (p = 0.064 and p = 0.062, respectively). The AUC for prediction of treatment success was 0.71 (95% CI, 0.61–0.82) for PCTc and 0.71 (95% CI, 0.61–0.81) for CRPc. The AUC for survival prediction was 0.77 (95% CI, 0.66–0.88) for PCTc and 0.77 (95% CI, 0.67–0.88) for CRPc. Changes in PCT and CRP concentrations were associated with outcomes of critically ill septic patients. CRP may not be inferior to PCT in predicting outcome in these patients.     

学龄前儿童细菌性腹泻的病原学特征及PCT、CD64和sTREM-1测定的临床意义

目的:分析学龄前儿童细菌性腹泻的病原学特征及血清中降钙素原(PCT)、中性粒细胞分化群64(CD64)和髓样细胞触发受体-1(s TREM-1)检测的临床意义。方法:选择2017年1月～2018年3月南方医科大学附属东莞市人民医院收治的214例学龄前感染性腹泻患儿为研究对象,包括细菌性腹泻(细菌组,n=101)和病毒性腹泻(病毒组,n=113),以同期入院行儿童保健的113例健康学龄前儿童为对照组。统计细菌组患儿的病原菌种类,比较两组腹泻患儿与对照组儿童血清PCT、CD64和s TREM-1水平的差异、三种血清学指标的阳性率及三种指标对细菌性腹泻患儿的诊断效能。结果:101例细菌性腹泻患儿粪便培养的细菌菌株中,共培养菌株213株,大肠埃希菌、志贺菌属和沙门菌属阳性率最高,分别占41.78%、23.01%和15.96%;细菌组的血清PCT、CD64和s TREM-1水平及阳性率均高于病毒组和对照组,且病毒组的s TREM-1水平高于对照组(P0.05);三种指标的灵敏度、特异度、阳性预测值和阴性预测值比较,差异无统计学意义(P0.05)。结论:学龄前儿童细菌性腹泻的致病菌主要为革兰阴性菌,PCT、CD64和s TREM-1均可作为判断细菌性腹泻的早期敏感指标。     

血清降钙素原在鉴别细菌性感染与自身免疫性疾病活动期中的应用价值

目的：探讨血清降钙素原（procalcitonin,PCT）在鉴别诊断自身免疫性疾病活动期与细菌感染中的应用价值。方法：选择析深圳市保健办2011年1月-2012年3月收治的30例自身免疫性疾病活动期和34例细菌感染患者为研究对象,测定其血清c反应蛋白（C-reactive protein,CRP）和PCT的水平。结果：感染组患者CRP水平为（0．1162±0．0873）gm,PCT水平（2．37±7．02）±10^-3gm,自身免疫活动期患者CRP水平（0．0639±0．0687）gm,PCT浓度（0．09±0．08）×10^-3g／L。ROC曲线下面积（AUC）和95％可信区间（CI）分别为0．75和0186,0．61-0．83和0．74-0．94,差异具有统计学意义（P〈0．05）。CRP联合PCT水平预测的AUC为0．82．其与单独PCT水平相比没有显著性差别（P=0．74）。CRP的最佳临界值为0．0722g／L,灵敏度为73．5％,特异性为69．2％;PCT的最佳临界值为0．09×10^-3g/L,其灵敏度为82．1％,特异性为72．5％。结论：在鉴别活动期自身免疫疾病患者与细菌感染时,PCT的灵敏度与特异性比CRP高,但其联合CRP对此类诊断并无显著意义。     

血清PCT、CRP及IL-6联合检测诊断细菌性血流感染的临床价值分析

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白介素-6(IL-6)联合检测诊断细菌性血流感染(BSI)的临床价值。方法:选取我院2015年8月到2016年10月收治的疑似细菌性BSI患者216例,入院后均送检血培养,根据培养结果将其分为阳性组(102例)和阴性组(114例)。统计细菌性BSI阳性率、革兰阳性菌感染率和革兰阴性菌感染率;检测血清PCT、CRP、IL-6水平,并比较两组患者的差异,同时绘制ROC曲线并计算出各指标及联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数值。结果:所有疑似BSI患者的细菌阳性检出率为47.22%,革兰阳性菌感染率与革兰阴性菌感染率对比无差异(P0.05);阳性组的血清PCT、CRP、IL-6水平均明显高于阴性组(P0.05);血清IL-6的AUC明显大于PCT和CRP(P0.05);PCT、CRP及IL-6联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数均明显高于单项检测(P0.05)。结论:血清PCT、CRP及IL-6对于BSI均有着一定诊断价值,而各指标联合检测诊断BSI的临床价值更高。     

血清降钙素原检测对早期诊断肝衰竭合并感染的临床意义

目的:探讨血清降钙素原(PCT)检测在肝衰竭合并感染早期诊断中的临床意义。方法:选择2014年3月至2017年3月我院收治的由病毒性肝炎导致的肝衰竭患者102例为研究对象,根据有无感染分为感染组(75例)和非感染组(27例),采用干式免疫荧光法检测其血清PCT水平,并检测两组患者白细胞(WBC)水平、C反应蛋白(CRP)水平、中性粒细胞百分比(N%),进行全身炎症反应综合征(SIRS)评分,采用多因素Logistic回归模型分析PCT、WBC、CRP、N%水平和SIRS评分对肝衰竭合并感染的预测价值大小,绘制受试者工作特征曲线(ROC曲线)评价PCT、WBC、CRP、N%水平和SIRS评分对肝衰竭合并感染的诊断价值。结果:感染组PCT、WBC、N%、CRP水平和SIRS评分均高于非感染组(P0.05);不同感染部位患者WBC、N%、CRP水平和SIRS评分比较差异不明显(P0.05);多部位感染患者血清PCT水平均高于其他单部位感染患者(P0.05);多因素Logistic回归分析显示,PCT和N%水平是肝衰竭合并感染的独立危险因素(P0.05);PCT、N%、CRP、WBC水平和SIRS评分诊断肝衰竭合并感染的ROC曲线下面积(AUC)值依次为0.916、0.763、0.752、0.746、0.682,PCT诊断肝衰竭合并感染的AUC值分别与N%、CRP、WBC和SIRS评分比较差异均有统计学意义(Z=3.518、3.672、4.103、5.106,P0.05)。结论:肝衰竭合并感染患者血清PCT水平明显升高,PCT对肝衰竭合并感染的诊断价值优于WBC、CRP、N%和SIRS评分等传统实验室指标。     

血清乳酸脱氢酶评估颅脑手术患者重症肺炎的临床价值

摘要 目的：分析血清乳酸脱氢酶在评估颅脑手术患者重症肺炎的中的应用价值。方法：选取2020年7月~2022年6月在本院神经外科进行收治的颅脑择期手术患者268例,根据是否合并术后肺炎,分为非感染组（n=185）和肺炎组（n=83）,肺炎组根据肺炎严重程度分为重症肺炎31例及普通肺炎52例。采用酶联免疫吸附法测定血清PCT、CRP水平;采用酶比色法检测血清 LDH 水平,采用Pearson相关性检验分析合并肺炎患者血清LDH、PCT、CRP水平与病情严重程度的相关性。采用ROC曲线分析血清LDH、PCT、CRP水平对颅脑手术患者合并重症肺炎的临床诊断价值,血清LDH、PCT、CRP水平预估颅脑手术合并重症肺炎患者预后的价值。结果：术后1 d、3 d、7 d与未感染组对比,普通肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）;与普通肺炎组对比,重症肺炎组患者血清LDH、PCT、CRP水平均明显升高（P<0.05）。经Pearson相关性检验分析,颅脑手术合并肺炎患者血清LDH、PCT、CRP水平与PSI评分呈明显正相关（P<0.05）。以术后1 d血清LDH、PCT、CRP水平建立ROC曲线,结果发现,血清LDH、PCT、CRP的曲线下面积分别为0.840、0.825、0.746。以术后7 d血清LDH、PCT、CRP水平建立ROC曲线,结果发现,血清LDH、PCT、CRP的曲线下面积分别为0.819、0.725、0.684。结论：LDH在颅脑手术合并肺炎患者中高表达,与肺炎严重程度正相关。LDH在区分非重症肺炎患者和重症肺炎患者以及预测重症肺炎患者的28天死亡率方面具有良好价值。     

高压氧联合支气管肺泡灌洗对重型颅脑损伤肺部感染患者临床疗效及血清sTREM-1、HMGB1、CRP/Alb水平的影响

摘要 目的：探讨高压氧（HBO）联合支气管肺泡灌洗对重型颅脑损伤肺部感染（PI）患者临床疗效及血清可溶性髓系细胞触发受体-1（sTREM-1）、高迁移率族蛋白B1（HMGB1）、C反应蛋白/白蛋白（CRP/Alb）水平的影响。方法：选取2019年9月-2022年9月安徽中医药大学附属六安医院收治的72例重型颅脑损伤PI患者为研究对象,按随机数字表法分为观察组和对照组,每组各36例。对照组采用支气管肺泡灌洗治疗,观察组采用HBO联合支气管肺泡灌洗治疗。收集两组临床资料,对比两组临床疗效、治疗前后临床体征[体温、动脉血氧分压（PaO₂）,血白细胞计数（WBC）]、临床肺部感染评分（CPIS）、全身炎症反应综合征修正（ASS）评分、格拉斯哥昏迷评分（GCS）、血清指标（sTREM-1、HMGB1、CRP/Alb）。结果：观察组治疗总有效率94.44%高于对照组的77.78%（P＜0.05）;治疗后观察组体温、WBC、CPIS评分、ASS评分低于对照组,PaO₂、GCS评分高于对照组（P＜0.05）;治疗后观察组血清sTREM-1、HMGB1、CRP/Alb水平低于对照组（P＜0.05）。结论：HBO联合支气管肺泡灌洗治疗重型颅脑损伤PI能减轻炎症反应,降低PI程度,减轻临床体征,提高临床疗效。     

血清PCT、CRP以及T淋巴细胞亚群的动态变化及与胃癌患者术后感染性并发症的关系

目的:探讨血清降钙素原(PCT)和C反应蛋白(CRP)以及T淋巴细胞亚群的动态变化及与胃癌患者术后感染性并发症的关系。方法:选取2014年1月到2017年10月期间在中国人民解放军联勤保障部队第967医院接受治疗的胃癌患者163例,根据患者术后是否出现感染性并发症将其分为感染组和未感染组,其中感染组83例,未感染组80例,计算感染组患者各种术后感染性并发症的构成比例,检测术前、术后1d、术后3d血清PCT、CRP以及T淋巴细胞亚群的动态变化。采用ROC曲线分析PCT、CRP对感染性并发症的预测价值。结果:胃癌患者术后感染性并发症种类主要为肺部感染和手术部位感染,其次为腹腔感染和十二指肠残端瘘。术后1d、术后3d两组患者血清中PCT、CRP的水平明显高于术前(P0.05),术后1d、术后3d感染组患者血清中PCT的水平高于未感染组(P0.05),术后3d感染组血清中CRP的水平较未感染组升高(P0.05);经ROC曲线分析显示,术后3d血清PCT对胃癌患者术后感染性并发症的曲线下面积(AUC)为0.90,高于CRP的0.81;术后1d、术后3d两组患者的CD3~+、CD4~+、CD4~+/CD8~+均明显低于术前,术后1d、术后3d感染组患者的CD8~+明显高于术前(P0.05);术后3d感染组患者的CD3~+、CD4~+、CD4~+/CD8~+均明显低于未感染组(P0.05)。结论:血清PCT、CRP以及T淋巴细胞亚群的动态变化与胃癌患者术后感染性并发症密切相关,且PCT对胃癌患者术后感染性并发症的预测价值高于CRP。     

PCT和CRP在感染性疾病诊断中的临床意义

目的:探讨PCT、CRP在感染性疾病诊断中的价值,评价两者与感染类型的相关性。方法:回顾性统计分析420例发热待查的患者血清PCT,血浆CRP浓度与感染的关系,采用胶体金法检测血清中PCT的浓度,免疫荧光比色法检测血浆中CRP浓度,血培养及血清学的方法检测感染是否存在及感染类型。结果:通过血培养或血清学鉴定出132例存在细菌感染(细菌组),病毒感染103例(病毒组),细菌病毒混合感染76例(混合感染组),109例阴性(非感染组)。PCT在细菌组水平最高(20.6±6.7)μg/L,非感染组水平最低(8.7±2.3)μg/L,四组间差异有统计学意义(F=34.69,P0.05)。CRP在混合组中水平最高(18.1±3.7)mg/L,在非感染组水平最低(5.8±1.7)mg/L,四组间差异有统计学意义(F=23.55,P0.05)。PCT对细菌感染检测的敏感度为92.7%,特异度为63.2%。PCT对病毒感染检测的敏感度为78.7%,特异性为46.0%。细菌感染组、病毒感染组和混合感染组血清CRP和PCT均呈正相关(P=0.000.05)。结论:细菌感染的PCT、CRP血清浓度明显高于病毒感染,两者对细菌感染患者的特异性均明显高于病毒感染,细菌感染PCT血清浓度较CRP变化敏感。     

血清TRAF-6、MCP-1、sTREM-1、IL-33水平与脓毒症严重程度及与合并急性肾损伤关系的临床分析

目的:探讨脓毒症患者血清肿瘤坏死因子受体相关因子(Tumor necrosis factor receptor-related factor,TRAF)-6、单核细胞趋化蛋白(Monocyte chemotactic protein,MCP)-1、可溶性髓样细胞触发受体(Soluble myeloid cell trigger receptor,s TREM)-1、白介素(Interleukin,IL)-33水平的变化及与病情严重程度及合并急性肾损伤(acute kidney injury, AKI)的相关性。方法:选择2014年2月到2018年7月在我医院ICU病房进行诊治的脓毒症患者145例,分析脓毒症相关性急性肾损伤(sepsis-associated AKI,SAKI)的发生情况,比较SAKI和非SAKI患者血清TRAF-6、MCP-1、s TREM-1、IL-33水平,采用Pearson相关分析血清TRAF-6、MCP-1、s TREM-1、IL-33含量与APACHEⅡ评分、SOFA评分的相关性,多因素logistic回归分析脓毒症患者发生SAKI的影响因素。结果:在145例患者中,发生SAKI者69例,发生率为47.6%。SAKI组患者的年龄、性别、原发病、白细胞(white blood cell,WBC)计数、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、体重指数、BUN、Scr与eGFR值与非SAKI组患者对比差异均无统计学意义(P0.05)。SAKI组患者APACHEⅡ评分、SOFA评分血清TRAF-6、MCP-1、s TREM-1、IL-33含水平含量均显著高于非SAKI组患者(P0.05)。Pearson相关性分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平与SAKI患者的急性生理和慢性健康Ⅱ(acute physiology and chronic health evaluation II,APACHEⅡ)评分、序贯多器官功能障碍(sequential organ failure assessment,SOFA)评分均呈显著正相关性(P0.05)。logistic回归分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平升高均为影响SAKI发生的独立危险因素(P0.05)。结论:血清TRAF-6、MCP-1、s TREM-1、IL-33水平与脓毒症严重程度显著相关,可能作为诊断和治疗SAKI的参考指标及干预靶点。     

Differential pattern of cell-surface and soluble TREM-1 between sepsis and SIRS

ObjectiveTriggering receptor expressed on myeloid cells-1 (TREM-1) was reported to play a key roll in amplification of production of inflammatory cytokines. TREM-1 is suggested to be a specific biomarker for sepsis for this reason, but the clinical significance of TREM-1 has not been elucidated. We investigated TREM-1 expression on the cell-surface, and plasma levels of soluble TREM-1 (sTREM-1) in patients with non-infectious systemic inflammatory response syndrome (SIRS) and sepsis admitted to the ICU.MethodsThirty-five patients with SIRS and 21 patients with sepsis admitted to ICU were subjected to the study. TREM-1 expressions on the surfaces of monocytes and neutrophils were measured by flow cytometry. Plasma sTREM-1 level and serum interleukin (IL)-6 level were measured.ResultsSeptic patients had decreased TREM-1 expression, clearly on neutrophils or to a lesser extent on monocyte compared to SIRS patients on ICU admission (neutrophils p < 0.001, monocyte p < 0.05). TREM-1 expression on neutrophils had a significant inverse correlation with serum IL-6 level (r = ?0.64, p < 0.0001). Plasma sTREM-1 level in septic patients was significantly higher than that in SIRS patients (p < 0.05). Plasma sTREM-1 level positively correlated with severity score and non-survivors had increased plasma sTREM-1 level compared to survivors in all SIRS/sepsis patients (p < 0.05).ConclusionsPatients with sepsis had increased soluble TREM-1 and decreased TREM-1 expression on neutrophil compared to SIRS patients. sTREM-1 may be useful to evaluate disease severity and outcome of patients with SIRS or sepsis.     

脓毒症患儿血清SAA、PCT、CRP水平与预后的关系及其诊断价值分析

摘要 目的：探讨脓毒症患儿血清淀粉样蛋白A（SAA）、降钙素原（PCT）、C反应蛋白（CRP）与预后的关系,并分析三者对脓毒症的诊断价值。方法：纳入我院于2016年8月～2020年6月期间收治的脓毒症患儿60例开展回顾性研究,作为脓毒症组,选取同期于我院进行体检的健康儿童40例作为对照组,比较两组血清SAA、PCT、CRP水平。根据脓毒症患儿1个月内的生存、死亡情况,分成生存组（n=42）、死亡组（n=18）,比较两组临床资料及血清SAA、PCT、CRP水平,经COX回归模型分析脓毒症患儿死亡的危险因素。绘制受试者工作特征（ROC）曲线分析血清SAA、PCT、CRP对脓毒症的诊断价值。结果：脓毒症组血清SAA、PCT、CRP水平显著高于对照组（P＜0.05）。死亡组器官障碍数量＞2个、脓毒性休克患儿占比分别为55.56%、44.44%,显著高于生存组的19.05%、9.52%（P＜0.05）;死亡组入院后1 h内使用抗菌治疗患儿占比为38.89%,显著低于生存组的69.05%（P＜0.05）;死亡组血清SAA、PCT、CRP水平高于生存组（P＜0.05）。COX多因素分析结果显示,器官障碍数量＞2、脓毒性休克及血清SAA、PCT、CRP水平升高是脓毒症患儿死亡的危险因素（P＜0.05）,而入院后1 h内使用抗菌治疗是脓毒症患儿死亡风险的保护性因素（P＜0.05）。血清SAA、PCT、CRP单独及三者联合诊断脓毒症的曲线下面积（AUC）分别为0.808、0.780、0.761、0.912。结论：脓毒症患儿血清SAA、PCT、CRP明显升高,三者升高均为脓毒症患儿死亡的危险因素,且对脓毒症具有一定诊断价值。     

The Diagnostic and Prognostic Accuracy of Five Markers of Serious Bacterial Infection in Malawian Children with Signs of Severe Infection

Background

Early recognition and prompt and appropriate antibiotic treatment can significantly reduce mortality from serious bacterial infections (SBI). The aim of this study was to evaluate the utility of five markers of infection: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), CD163 and high mobility group box-1 (HMGB1), as markers of SBI in severely ill Malawian children.

Methodology and Principal Findings

Children presenting with a signs of meningitis (n = 282) or pneumonia (n = 95), were prospectively recruited. Plasma samples were taken on admission for CRP, PCT, sTREM-1 CD163 and HMGB1 and the performance characteristics of each test to diagnose SBI and to predict mortality were determined. Of 377 children, 279 (74%) had SBI and 83 (22%) died. Plasma CRP, PCT, CD163 and HMGB1 and were higher in HIV-infected children than in HIV-uninfected children (p<0.01). In HIV-infected children, CRP and PCT were higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and PCT and CD163 were higher in non-survivors (p = 0.001, p = 0.05 respectively). In HIV-uninfected children, CRP and PCT were also higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and CD163 was higher in non-survivors (p = 0.05). The best predictors of SBI were CRP and PCT, and areas under the curve (AUCs) were 0.81 (95% CI 0.73–0.89) and 0.86 (95% CI 0.79–0.92) respectively. The best marker for predicting death was PCT, AUC 0.61 (95% CI 0.50–0.71).

Conclusions

Admission PCT and CRP are useful markers of invasive bacterial infection in severely ill African children. The study of these markers using rapid tests in a less selected cohort would be important in this setting.     

血清降钙素原(PCT)在新生儿感染中的临床应用价值

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)、淀粉样蛋白(SAA)、外周血白细胞计数(WBC)及中性粒细胞比例(N)在新生儿感染中的临床应用价值。方法:随机选取2015年10月~2017年6月在我院治疗并确诊感染的出生三日内的新生儿106人,以及未感染新生儿57人,将其分为未感染组、一般感染组及败血症组,比较其血清PCT、CRP、SAA、WBC及中性粒细胞比例。结果:败血症组的N、PCT均高于未感染组(P0.05),而败血症组的WBC高于或者低于未感染组(P0.05);一般感染组的N、PCT均高于未感染组(P0.05);败血症组PCT高于感染组(P0.05)。WBC、N、PCT用于鉴别诊断一般感染和败血症的ROC曲线的曲线下面积依次为0.551、0.580、0.815,当PCT的值设为6.785 ng/mL时,其鉴别诊断一般感染和败血症的灵敏度50.0%,特异度为97.7%。结论:PCT对于诊断败血症有较高的诊断价值,能有效鉴别一般感染和败血症,中性粒细胞比例和白细胞在诊断细菌感染方面是PCT的补充,三者联合诊断可以提高新生儿细菌感染的诊断准确性。     

sTREM-1、PCT在社区获得性肺炎早期诊断中的价值

目的:探讨可溶性髓系细胞触发受体-1(soluble triggeringreceptorexpressed on myeloidcells-1,sTREM-1)、降钙素原(procalcitonin,PCT)在社区获得性肺炎(community-acquired pneumonia,CAP)早期诊断中的价值。方法:选择48例CAP住院患者(其中重症肺炎8例)和病毒性上呼吸道感染患者20例,所有病例均在入院后24小时内取血清,采用酶联免疫测定法(ELISA法)测定其血清sTREM-1、PCT水平,并应用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析二者对CAP的诊断价值。结果:入院后24小时内,普通肺炎患者、重症肺炎患者血清sTREM-1、PCT水平均明显高于对照组,且重症肺炎组明显高于普通肺炎组,差异均具有统计学意义(P0.01)。二者诊断CAP的ROC曲线下面积分别为0.884、0.788,联合二者诊断CAP的ROC曲线下面积为0.921。结论:sTREM-1、PCT均可作为CAP早期诊断有价值的参考标志物,sTREM-1比PCT更有参考价值,联合检测血清sTREM-1、PCT水平对CAP的早期诊断价值高于单一指标。     

脓毒症患者血清炎症因子与SOFA评分的关系研究

目的:探究脓毒症患者血清炎症因子与序贯器官衰竭评估(SOFA)评分的关系,从而有助于评价患者病情严重程度,科学判断预后效果。方法:选择2014年1月至2015年12月期间在本院内接受治疗的脓毒血症患者142例作为研究对象。入院后24 h内患者进行血清炎症因子IL-6、PCT、CRP水平测定,同时进行SOFA评分。按照患者在入院治疗28天内生存结局状况进行分组,分别为死亡组(87例)和存活组(55例),另按照患者合并多器官功能障碍综合症(MODS)与否,分为MODS组(76例)和非MODS组(66例),对比不同组别间IL-6、PCT、CRP及SOFA评分差别;对比不同SOFA评分患者血清IL-6、PCT、CRP水平差异,分析其相关性。结果:IL-6、PCT以及SOFA评分比较,死亡组高于存活组,MODS组高于非MODS组,差异有统计学意义(P0.05);SOFA评分越高,血清IL-6、PCT水平越高,差异有统计学意义(P0.05);SOFA评分升高,患者病死率显著增加,SOFA10分,病死率为78.3%,差异有统计学意义(P0.05);Spearman相关分析结果显示,SOFA评分与血清IL-6水平呈显著正相关关系(r=0.261,P=0.012),与血清PCT水平呈正相关关系(r=0.453,P=0.000),SOFA与CRP水平无相关性(r=0.112,P=0.323)。结论:血清IL-6、PCT水平与SOFA评分具有相关性,可以在脓毒症患者病情严重程度及预后状况判断中作为生物学指标进行常规监测。