【摘要】 目的探究呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)新生儿血清、支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)及呼出气冷凝液(exhaled breath condensate,EBC)中可溶性髓系细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1,s TREM-1)水平检测的临床意义。方法选取2013年6月至2018年6月本院疑似VAP的328例住院新生儿为研究对象,根据诊断结果将其分为VAP组(152例)和非VAP组(176例)。统计两组患儿临床指标及28天死亡情况,于诊断为疑似VAP当天采集患儿血清、BALF及EBC,并测定其sTREM-1水平。结果 VAP组患儿机械通气时间、用氧时间、血清C反应蛋白(C reactive protein,CRP)及BALF、EBC中sTREM-1水平均显著高于非VAP组(P_均<0.05);BALF中sTREM-1水平ROC曲线下面积最大,最佳截点为125.16 ng/L,此时的诊断灵敏度、特异度分别为88.6%、73.1%;152例VAP组患儿均接受随访,28天病死率为21.71%(33/152)。多因素Logistic回归分析显示,BALF和EBC中,高sTREM-1水平是导致VAP患儿预后差的危险因素(P_均<0.05)。结论检测BALF和EBC中sTREM-1水平对新生儿VAP具有较好的诊断价值,也可将其作为评估新生儿VAP预后的指标之一。更多还原

【Abstract】 Objective To investigate the clinical significance of detection of soluble triggering receptor expressed on myeloid cells-1（s TREM-1） in serum,bronchoalveolar lavage fluid（BALF） and exhaled breath condensate（EBC） of neonates with ventilator-associated pneumonia（VAP）.Method The 328 cases of suspected VAP neonates in our hospital from June 2013 to June 2018 were collected for the study,they were divided into VAP group（152 children） and non-VAP group（176 children） according to the diagnosis result.The clinical indicators and 28-day mortality situation were collected.Serum,BALF and EBC were collected on the day of diagnosis of suspected VAP.The levels of s TREM-1 in the three samples were determined.Result The mechanical ventilation time,oxygen time,serum C-reactive protein（CRP）,and s TREM-1 levels in BALF and EBC in VAP group were significantly higher than those in non-VAP group(P_all<0.05).Area under curve of sTREM-1 level was the largest in BALF,and the optimal cut-off point was 125.16 ng/L.At this time,the diagnostic sensitivity and specificity were 88.6% and 73.1%,respectively;152 children in VAP group were all followed up,and the mortality rate was 21.71% at 28 th day.Multivariate Logistic regression analysis showed that high level of s TREM-1 in BALF and EBC were risk factors of poor prognosis in children with VAP(P_all<0.05).Conclusion The level of s TREM-1 in BALF and EBC has a good diagnostic value for neonatal VAP,and it can also be used as an indicator to evaluate the prognosis of VAP children.更多还原