【摘要】 目的 探讨血清可溶性髓样细胞体-1(sTREM-1)在血流感染中的诊断及预后价值。方法 选择川北医学院附属医院2018年10月至2020年5月临床科室疑似血流感染患者191例，根据诊断结果分为血流感染组110例和局部感染组81例，同期健康体检者30例，利用非参数检验比较不同分组中患者血清sTREM-1、PCT、白细胞计数、中性粒细胞百分比等指标差异；利用受试者工作特征曲线(ROC)评价血清sTREM-1等各炎症指标对于血流感染的早期诊断价值；根据出院时疾病转归情况将血流感染组分为好转组50例和死亡组9例，利用单因素分析法及多因素Logistic回归比较分析血清sTREM-1与各指标影响血流感染预后。结果 (1)血清sTREM-1水平在血流感染组(735.38,1945.92)pg/ml>局部感染组(514.87,1071.22)pg/ml>健康体检组(173.26,308.24)pg/ml(P<0.001);(2)血清sTREM-1、PCT、体温、中性粒细胞百分比诊断血流感染的ROC曲线下面积分别为0.707、0.675、0.629、0.610(P<0.001);(3)血清sTREM-1[G+(720.98,1995.55)pg/ml vs.G-(738.63,1920.44)pg/ml, Z=-0.930,P=0.352]、PCT[G+(0.94,7.99)ng/ml vs.G-(0.61,19.59)ng/ml,Z=-0.071,P=0.943]值在革兰阳性菌与革兰阴性菌血流感染患者中差异无统计学意义(P>0.05);(4)血清PCT[(3.39,42.83)vs.(0.97,10.28),Z=-2.224,P=0.026]、血清sTREM-1[(813.42,2338.55)vs.(591.84,1700.25),Z=-2.045,P=0.041]在死亡组中高于好转组，血浆白蛋白死亡组低于好转组[(20.00,29.35)vs.(26.89,35.53),Z=-2.815,P=0.005],差异有统计学意义(P<0.05);血浆白蛋白、血清sTREM-1为血流感染患者预后的独立危险因素(P<0.05)。结论 血清sTREM-1及PCT对于血流感染有一定早期诊断价值，且血清sTREM-1诊断效能稍优于血清PCT;血清sTREM-1不能很好的预测细菌性血流感染的病原菌类型；血清sTREM-1对血流感染的严重程度、预后及转归有一定的预测价值；同时血清sTREM-1为影响血流感染患者预后的独立危险因素。更多还原

【Abstract】 Objective To investigate the diagnostic and prognostic values of serum soluble myeloid cell receptor-1(sTREM-1)in bloodstream infection. Methods From October 2018 to May 2020, 191 patients with suspected bloodstream infection in clinical department of affiliated hospital were selected. According to diagnostic results, they were divided into 110 patients in the bloodstream infection group, 81 patients in the local infection group and 30 healthy people in the same period. Differences of serum sTREM-1, PCT, leukocyte count, neutrophil percentage and other indicators in different groups were compared by nonparametric test. The receiver operating characteristic curve(ROC)was used to evaluate the early diagnostic value of serum sTREM-1 and other inflammatory indexes for bloodstream infection. According to disease outcome at discharge, blood flow infection group was divided into 50 patients in the improvement group and 9 patients in the death group.Effects of serum sTREM-1 and various indexes on the prognosis of blood flow infection were compared and analyzed by univariate analysis and multivariate logistic regression. Results(1)Serum sTREM-1 in blood flow infection group(735.38, 1945.92)pg/ml>local infection group(514.87,1071.22)pg/ml>physical examination group(173.26, 308.24)pg/ml(P<0.001).(2)The areas under the ROC curve of serum sTREM-1, PCT, body temperature and neutrophil percentage in the diagnosis of blood flow infection were 0.707, 0.675, 0.629 and 0.610, respectively(P<0.001).(3)There was no significant difference in serum sTREM-1[G +(720.98, 1995.55)pg/ml vs. G-(738.63,1920.44)pg/ml, Z=-0.930, P=0.352], PCT [G +(0.94, 7.99)ng/ml vs. G-(0.61, 19.59)ng/ml, Z=-0.071, P=0.943] between patients with gram-positive and Gram-negative blood flow infection(P>0.05).(4)Serum PCT [(3.39,42.83)vs.(0.97,10.28), Z=-2.224, P=0.026], serum sTREM-1 [(813.42,2338.55)vs.(591.84,1700.25), Z=-2.045, P=0.041] in the death group was higher than that in the improvement group, and plasma albumin in the death group was lower than that in the improvement group [(20.00,29.35)vs.(26.89,35.53), Z=-2.815, P=0.005] with statistically significant difference(P<0.05). Plasma albumin and serum sTREM-1 were independent risk factors for the prognosis of patients with bloodstream infection(P<0.05). Conclusion Serum sTREM-1 and PCT have certain early diagnostic value for blood flow infection, and the diagnostic efficacy of serum sTREM-1 is slightly better than that of serum PCT. Serum sTREM-1 can not well predict the pathogen type of bacterial bloodstream infection. Serum sTREM-1 can predict the severity, prognosis and outcome of blood flow infection. At the same time, serum sTREM-1 is an independent risk factor affecting the prognosis of patients with bloodstream infection.更多还原