陈玺.降钙素原、白细胞介素-17和可溶性髓系细胞触发受体1水平的检测在机械通气并呼吸机相关性肺炎患者中的意义[J].内科急危重症杂志,2019,25(4):309-312
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| DOI：10.11768/nkjwzzzz20190414 |
| 中文关键词: 机械通气 呼吸机相关性肺炎 降钙素原 白细胞介素17 可溶性髓系细胞触发受体1 |
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| 中文摘要: |
| 目的：探讨机械通气并呼吸机相关性肺炎（VAP）患者降钙素原（PCT）、白细胞介素-17（IL-17）和可溶性髓系细胞触发受体1（sTREM-1）的水平及其临床意义。方法：选择重症监护室110例机械通气患者，根据是否发生VAP分为VAP组和非VAP组，比较2组患者的血清和支气管肺泡灌洗液（BALF）中的PCT、IL-17和sTREM-1的水平。应用受试者工作曲线（ROC）评价三项指标单独和联合诊断VAP的诊断效能（包括诊断准确率、灵敏度、特异度、阳性预测值和阴性预测值等）。结果：2组患者血清PCT、IL-17和sTREM-1水平比较，差异无统计学意义（均P>0.05）；VAP组患者BALF中PCT、IL-17和sTREM-1的水平显著高于非VAP组（P<0.05）。ROC曲线显示，应用BALF中PCT、IL-17、sTREM-1水平单独和联合预测VAP的AUC分别为0.887、0.759、0.788和0.959，其最佳截点分别为sTREM-1≥201.33pg/mL、PCT≥2.06ng/mL和IL-17≥6.38μg/mL。与PCT和IL-17相比，sTREM-1的敏感度较高而特异度较低（P<0.05），三项指标的诊断准确率比较,差异无统计学意义（P>0.05）。以sTREM-1≥201.33pg/mL和PCT≥2.06ng/mL或IL-17≥6.38μg/mL为联合诊断指标，联合诊断的准确率、特异度和阳性预测值得到明显提高（P<0.05）。结论: 机械通气并发VAP患者BALF中的PCT、IL-17和sTREM-1水平明显升高，应用三项指标联合诊断VAP的效能较高。 |
| 英文摘要: |
| Objective: To explore the clinical significance of procalcitonin (PCT), interleukin-17 (IL-17), soluble myeloid cell-triggered receptor 1 (sTREM-1) in patients with mechanical ventilation complicated with ventilator associated pneumonia (VAP). Methods: The levels of PCT, IL-17 and sTREM-1 in 110 patients undergoing mechanical ventilation in intensive care unit with suspected VAP were comparatively analyzed. The patients were divided into VAP group and non-VAP group.The receiver operating curve was used to evaluate the diagnostic efficacy (including diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value, respectively) for the diagnosis of VAP of three indicators. Results: There was no significant difference in the serum levels of PCT, IL-17 and sTREM-1 between the two groups (all P>0.05). The levels of PCT, IL-17 and sTREM-1 in BALF of VAP group were significantly higher than those in non-VAP group (P<0.05). The ROC curves showed that the AUCs of PCT, IL-17, sTREM-1 and combined diagnosis for the VAP were 0.887, 0.759, 0.788 and 0.959, respectively. The best cutoff points were sTREM-1≥201.33pg/mL, PCT ≥2.06ng/mL and IL-17 ≥6.38μg/mL. The sTREM-1 had higher sensitivity and lower specificity than PCT and IL -17 (P<0.05), and no significant differences were found in the diagnostic accuracy of the three indicators (P>0.05). By the combined diagnosis, the diagnostic accuracy, specificity and positive predictive values were significantly increased (P<0.05). Conclusions: The levels of PCT, IL-17 and sTREM-1 in BALF were significantly increased in patients with mechanical ventilation complicated with VAP, and the combination of three indexes in the diagnosis of VAP was more effective. |
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