余　娇， 梁显泉

(贵州医科大学 急诊教研室， 贵州 贵阳　550004)



可溶性髓细胞触发受体-1与多发伤的相关性

余娇*， 梁显泉**

(贵州医科大学 急诊教研室， 贵州 贵阳550004)

目的： 检测人血浆可溶性髓样细胞触发受体-1(sTREM-1)、降钙素原(PCT)和肿瘤坏死因子-α(TNF-α)水平，评价sTREM-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sTREM-1、PCT、TNF-α水平，分析sTREM-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sTREM-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sTREM-1、PCT及TNF-α均高于非严重创伤组(P<0.05)，脓毒症组sTREM-1、PCT及TNF-α均高于非脓毒症组(P<0.05)，血浆sTREM-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sTREM-l 0.819(95%CI0.693～0.945)、PCT 0.756 (95%CI0.611～0.901)、TNF-α0.576(95%CI0.407～0.746)，差异有统计学意义(P<0.05)；sTREM-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sTREM-1水平，死亡组高于存活组(P<0.05)。结论： sTREM-1对多发伤后并发脓毒症的早期预测价值优于PCT、TNF-α。

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

[Abstract]Objective: To investigate soluble triggering receptor expressing on myeloid cells-1 (sTREM-1), PCT, and TNF-α levels of patients, to investigate complicating sepsis and the efficacy of sTREM-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 sTREM-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 sTREM-1, PCT and TNF-α levels in early diagnosis of multiple traumas, especially the complicate sepsis. Results: sTREM-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). sTREM-1, PCT and TNF-α in the sepsis group were higher than the non-sepsis group, and differences had statistical significance (P<0.05). sTREM-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 respectively 0.819(95%CI0.693～0.945)for sTREM, 0.756 (95%CI0.611～0.901) for PCT and 0.576 (95%CI0.407～0.746) for TNF-α. All of the three indexes had statistical significance (P<0.05). The sensitivity degrees of sTREM-l, PCT and TNF-α were respectively 83.3%, 72.2% and 61.1%, and the specificity of sTREM-l, PCT and TNF-α were respectively 77.8%, 70.3% and 63.0%. The sTREM-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: sTREM-1 had greater predictive values be used as early-warning indexes for the occurrence of complicated sepsis after multiple traumas.

[Key words]sepsis； procalcitonin； tumor necrosis factor α； soluble triggering receptor-1； multiple traumas

多发伤是指在同一个伤因的打击下，人体同时或相继有两个或两个以上解剖部位的组织或器官受到严重创伤，其中一个单独创伤也会危及到患者生命[1]。我国每年约有十多万人死于多发伤，而且高发人群主要集中在40岁以下的青壮年[2-3]。脓毒症是多发伤后常见的并发症，创伤之后并发感染导致的死亡人数占总死亡人数的78%。目前采用超敏C反应蛋白和降钙素原(procalcitonin，PCT)预测脓毒症，存在敏感度及特异度较低、误诊率较高等缺点。临床上亟需一种适用度更高的特异性生物化学标志物用于多发伤并脓毒血症的早期诊断，以期提高患者生存率。……