胸腔积液可溶性髓系细胞触发受体1水平及意义

目的 探讨各种病因所致胸腔积液可溶性髓系细胞触发受体1(sTREM-1)的水平及意义.方法 分别收集细菌性胸腔积液(n=12)、结核性胸腔积液(n=31)、恶性肿瘤胸腔积液(n=35)和漏出液(n=15)患者的胸水和外周血标本,采用酶联免疫吸附测定法检测胸水和血清中sTREM-1的浓度.结果 4种类型的胸腔积液其胸水sTREM-1浓度均高于血清sTREM-l浓度(P＜0.05或＜0.01).细菌性胸腔积液其胸水和血清sTREM-l浓度均明显高于结核性胸腔积液、恶性肿瘤胸腔积液和漏出液,胸水sTREM-1[M(QR)]2 616.9(2 096.8)ng/L vs 286.0(348.0)ng/L、496.8(1 160.5)ng/L、102.3(266.5)ng/L(P＜0.01),血清sTREM-1 38.1(28.1)ng/L vs 0.2(19.8)ng/L、0.0(14.3)ng/L、15.7(67.6)ng/L(P＜0.01).结论 胸膜疾病胸腔积液TREM-1表达水平增高,以胸膜细菌感染时增高最明显,胸水sTREM-1浓度可以作为判断细菌感染的参考指标.     

不同钙浓度透析液在血液透析滤过中对钙磷代谢、甲状旁腺激素与醛固酮的影响

目的研究不同钙浓度透析液对血液透析滤过（HDF）中钙磷代谢、甲状旁腺素（iPTH）及醛固酮（ALD）的影响。方法60例慢性肾衰竭（CRF）伴难治性高血压患者分别用三种钙浓度透析液行HDF,测定HDF前后血清离子钙（iCa）、磷（P）、iPTH、ALD及血压水平。结果钙浓度1.25mmol/L（DCa1.25）组：iCa、P、ALD及血压均明显降低,iPTH无明显变化;钙浓度1.5mmol/L（DCa1.5）组：iCa无明显变化,P、ALD及iPTH降低;钙浓度1.75mmol/L（DCa1.75）组：iCa升高,P、iPTH及ALD降低。结论HDF中低钙透析不仅减轻高钙负荷和转移性钙化,同时不升高iPTH水平并明显降低ALD水平,可有效改善患者高血压。     

不同透析液钙浓度对血液透析患者血钙、血磷、甲状旁腺激素水平的影响

目的:分析不同透析液钙浓度对血液透析患者血钙、血磷、甲状旁腺激素水平的影响.方法:纳入90例血液透析患者,随机分为研究组与对照组,各45例.对照组采用1.50 mmol/L钙浓度透析液,研究组采用1.25 mmol/L钙浓度透析液.分析透析前及透析3个月后,两组患者血钙磷代谢(血钙、血磷、钙磷乘积)、全段甲状旁腺素及碱...     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

目的 观察脓毒症患者血浆可溶性髓系细胞表达的触发受体-1(sTREM-1)动态变化,探讨其与感染相关器官功能衰竭评分系统(SOFA)评分对预后的评价.方法 采用前瞻性随机对照研究.选择2009年5月至2010年6月天津医科大学第二医院重症监护病房(ICU)收治的32例脓毒症患者,根据28 d转归分为生存组(21例)和死亡组(11例),检测患者入院后1、3、7 d的血小板计数(PLT),并进行SOFA评分;采用酶联免疫吸附法(ELISA)检测血浆sTREM-1浓度.以同期25例健康体检者作为对照.结果 对照组PLT为(248.88±48.62)×109/L,sTREM-1为25.7(21.5,53.3)ng/L.脓毒症死亡组PLT(×109/L)1 d时即明显下降,且随病情进展呈下降趋势(1、3、7 d分别为95.77±47.42、91.92±35.78、82.31±31.04),SOFA评分(分)亦随之下降(1、3、7 d分别为12.36±4.30、10.90±5.32、7.87±4.60),sTREM-1(ng/L)1 d时即明显升高,且随病程进展呈上升趋势[1、3、7 d分别为360.5(262.2,434.5)、373.5(263.1,495.6)、496.6(380.0,571.8)3;生存组PLT(×109/L)3 d时降低后有所升高(1、3、7 d分别为152.94±85.59、136.18±75.30、165.41±61.36),SOFA评分(分)则逐渐下降(1、3、7 d分别为6.76±2.71、4.29±2.31、2.52±1.03),sTREM-1(ng/L)峰值出现在1 d时,然后随病程进展逐渐下降[1、3、7 d分别为204.1(175.0,269.6)、164.0(145.9,194.2)、81.5(62.1,109.0)].与生存组比较,死亡组各时间点PLT明显下降,SOFA评分、sTREM-1明显升高(P＜0.05或P＜0.01).血浆sTREM-1水平与PLT呈显著负相关(r=-0.257,P=0.042),与SOFA评分呈显著正相关(r=0.736,P=0.002).结论 脓毒症患者sTREM-1水平在发病早期即明显升高,其动态变化联合SOFA评分可能更有助于判断预后.

Abstract：

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

血液透析滤过和血液灌流联合血液透析对尿毒症患者血清钙磷及甲状旁腺激素清除的影响

目的 评估血液透析滤过和血液灌流联合血液透析血液净化方法对维持性血液透析尿毒症患者血清甲状旁腺激素及钙、磷的清除效果.方法 随机选取2009年5月至2010年10月在我院肾内科接受维持性血液透析的58例尿毒症患者,随机分为两组:血液灌流联合血液透析( HD+ HP)组(29例)和血液透析滤过(HDF)组(29例).上述患者每两周常规血液透析治疗5次,血液透析滤过治疗1次或血液灌流联合血液透析治疗1次.两组患者疗程均为12周.分别记录患者在首次透析前、治疗12周后血清钙、磷、甲状旁腺激素浓度,并对两组各指标进行比较.结果 HD+ HP组患者治疗前、后血清钙[(2.41±0.32)、(2.22±0.35) mmol/L,t=5.47,P ＜0.01]、磷[(1.98±0.34)、(1.70±0.31) mmol/L,t=8.13,P＜0.01]及甲状旁腺激素[(645.19±184.52)、(296.79±103.54) ng/L,t=6.54,P＜0.01]比较差异均有统计学意义,均较治疗前下降.HDF组患者治疗前、后血清钙[(2.43±0.33)、(2.32±0.37)mmol/L,t=6.72,P＜0.01)、磷[(1.97 ±0.36)、(1.83±0.35) mmol/L,t =6.47,P＜0.01]及甲状旁腺激素[ (639.47±208.73)、(409.91±152 72)ng/L,t=5.27,P＜0.01]比较差异均有统计学意义,均较治疗前下降.HD+ HP组血清磷及甲状旁腺激素下降优于HDF组(t值分别为4.24、7.24,P均＜0.01).结论 研究显示HD+ HP及HDF均能有效清除血清磷及甲状旁腺激素,而在清除效果方面HD+ HP优于HDF,值得临床进一步推广.     

脓毒症患者血浆可溶性髓系细胞表达的触发受体-1水平及意义

Objective To observe the dynamic changes in plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and to approach the effect on predicting outcome of the patient with sepsis combined with sepsis-related organ failure assessment (SOFA) score. Methods Using prospective,randomly control study design, 32 patients admitted to intensive care unit (ICU) of the Second Hospital of Tianjin Medical University suffering from sepsis between May 2009 and June 2010 were collected. They were divided into survival group (n = 21) and non-survival group (n=11) according to 28-day survival. Platelet count (PLT) was determined on the 1st, 3rd, 7th day and SOFA score was assessed. Levels of sTREM-1 in plasma were measured by enzyme linked immunosorbant assay (ELISA). Twenty-five health volunteers served as controls. Results The PLT was (248. 88 ± 48.62)×109/L and the level of sTREM-1 was 25.7 (21.5, 53.3) ng/L in the control group. In non-survivors, the level of PLT (×109/L) was significantly lower on 1st day with a tendency of degression (the level on 1st, 3rd, 7th day was 95. 77 ±47.42, 91. 92±35.78, 82.31±31.04, respectively), SOFA score decreased gradually (the score on 1st,3rd, 7th day was 12.36±4.30, 10.90±5.32, 7.87±4.60, respectively). On the contrary, the level of sTREM-1 (ng/L) was significantly higher on 1st day with a tendency of elevation [the level on 1st, 3rd, 7th day was 360. 5 (262. 2, 434. 5), 373. 5 (263.1, 495. 6), 496. 6 (380. 0, 571. 8), respectively]. In survivors,PLT (×109/L) began to decrease on the 3rd day, and then it increased (the level on 1st, 3rd, 7th day was 152. 94±85. 59, 136.18±75. 30, 165. 41±61. 36, respectively), SOFA score lowered gradually (the score on 1st, 3rd, 7th day was 6. 76±2. 71, 4. 29±2. 31, 2. 52±1. 03, respectively), the peak level of sTREM-1 (ng/L) appeared on the 1st day, then it decreased gradually [the level on 1st, 3rd, 7th day was 204.1 (175.0, 269.6), 164.0 (145.9, 194.2), 81.5 (62.1, 109.0), respectively]. PLT was significantly lower,and SOFA score and sTREM-1 were significantly higher in non-survivors than those of survivors at different time points (P＜0. 05 or P＜0. 01). The level of sTREM-1 showed obvious negative correlation with PLT (r=-0.257, P = 0.042), positive correlation with SOFA score (r=0.736, P = 0.002). Conclusion The plasma sTREM-1 concentration was elevated at the early stage in patients with sepsis. Dynamic changes in sTREM-1 level combined with SOFA score may be helpful in predicting outcome of the patient with sepsis.     

两种透析方法对尿毒症患者微炎症状态及毒素清除的疗效比较

目的比较高通量血液透析(HFHD)和血液透析滤过(HDF)对尿毒症患者微炎症状态及毒素清除的效果。方法选择重庆三博长安医院收治的尿毒症患者100例,随机分成两组,每组50例。对照组采用HDF治疗[2次低通量血液透析(LFHD)+1次HDF],治疗组采用HFHD治疗(2次LFHD+1次HFHD)。比较透析前后两组患者的C反应蛋白(CRP)、白细胞介素(IL)-6、甲状旁腺激素(PTH)、β2-微球蛋白(β2-MG)、肌酐、清蛋白水平。结果治疗后两组以上指标(除清蛋白外)水平较治疗前下降,差异均有统计学意义(P0.05),提示HFHD和HDF均能有效清除炎症介质及中、小分子毒素。与对照组比较,治疗组CRP、IL-6、PTH、β2-MG水平明显下降,差异均有统计学意义(P0.05),提示HFHD清除炎症介质及中分子毒素的效果更优于HDF。而在小分子毒素(肌酐)清除方面比较,二者差异无统计学意义(P0.05)。结论 HFHD可有效清除炎症介质及中、小分子毒素,并且治疗费用低,不需要特殊设备,值得临床推广。     

高通量透析器用于血液透析对透析患者血磷及PTH的影响

63.6 %的维持性血液透析患者存在着不同程度的继发性甲状旁腺功能亢进症 (SPHT) ,严重影响着患者的生存质量及生存率。曾有研究得出不同透析膜对血磷 (P)及甲状旁腺激素 (PTH)清除能力不同[1] ,本实验目的是探讨高通量血液滤过器进行血液透析是否可以降低血P及PTH的水平 ,减轻维持性血液透析 (MHD)患者的痛苦 ,提高患者生存质量及生存率。1　对象和方法1.1　对象选择在我院门诊维持性血液透析的CRF患者30例 ,其中男性 19例 ,女性 11例 ,年龄 19～ 78岁 ,平均年龄 (5 0 .2 5± 16 .5 3)岁。原发病分别为慢性肾小球肾炎 12例 ,糖尿病…     

不同血液净化方法对患者钙、磷、甲状旁腺激素、营养状态及生活质量的影响

目的 探究不同血液净化方法对血液透析患者钙、磷、甲状旁腺激素(iPTH)、营养状态及生活质量的影响.方法 前瞻性选取2019年6月至2021年1月汕头市中心医院血液净化中心收治的60例血液净化患者作为研究对象,按随机数表法将患者分为普通血液透析(HD)、透析+血液透析滤过(HD+HDF)、透析+血液灌流(HD+HP),...     

不同钙浓度透析液对糖尿病血液透析患者血压的影响

本研究探讨两种钙浓度透析液对糖尿病维持性血液透析患者血压的影响,现报告如下。1临床资料本院血液净化中心进行维持性血液透析的糖尿病患者15例,男12例,女3例;平均年龄（56.6±16.9）岁,透析龄（48.7±32.5）月;原发病均为糖尿病,无心功能不全,无顽固性高血压,干体质量稳定,脱水量无显著差异（P〉0.05）,原使用高血压药物不变,均不服用钙剂及活性维生素D制剂。     

脓毒症患者血清可溶性髓系细胞表达的触发受体-1水平及与预后的关系

Objective To approach the relationship between the contents of soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) and prognosis in patients with sepsis. Methods Using prospective, control study design, a total of 50 patients with sepsis who were admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University from March to December in the year of 2009 were enrolled. Firstly, the patients were divided into sepsis (n=28) and severe sepsis (n=22) groups according to the patients' condition. Then the patients were divided into survival group (n = 34) and death group (n = 16)according to the clinical outcome at 28 days after onset of sepsis. Clinical and laboratory data including blood routine tests, blood chemistry, blood gas analysis, C-reactive protein (CRP) and procalcitonin (PCT) were collected on the 1st, 3rd and 7th day after onset. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ ) score was determined. sTREM-1 levels were determined using enzyme linked immunosorbent assay (ELISA) method. Correlation analysis of the sTREM-1, APACHE I score, white blood cell count (WBC) and CRP, using Logistic regression analysis. A total of 30 healthy persons were enrolled into the control group. Results The sTREM-1 levels (ng/L) in 50 septic patients on the 1st day were higher than those of the healthy persons (52. 80±9. 30 vs. 23. 29±6. 22, P＜0. 01). The sTREM-1 levels (ng/L) in severe sepsis group on the 1st, 3rd and 7th day (58. 25±10. 59, 65. 75±13. 57, 50.18±21. 73) were higher than those of the sepsis group (48.55±5.20, 42.85±8.54, 34.02±12.86, P＜0.05 or P＜0.01). The sTREM-1 levels (ng/L) of the survival group on the 1st, 3rd and 7th day (53. 07± 10. 47, 45. 04±9. 89,32. 84 ±8. 42) were decreased with the progression of the ailment. The sTREM-1 levels did not differ significantly between the control group and survival group on the 7th day (P＞0. 05). The sTREM-1 levels (ng/L) in the death group on the 1st, 3rd and 7th day were increased with the progression of the ailment (52.27±6.42, 69.67±12.83, 75. 70± 10. 55), and the level was significantly higher than that in survival group on the 3rd and 7th day (both P＜0. 01). The contents of sTREM-1 were positive correlated with APACHE Ⅱ score (r= 0.657, P＜0. 01), but not correlated with WBC (r= 0.023, P＞0. 05), whilesomewhat correlated with CRP (r=0. 150, P＜0.10). Logistic regression analysis showed that sTREM-1 [odds ratio (OR) = 0. 893,P = 0. 000] and APACHE I score (OR = 0.771, P = 0.000) might be potential prognostic factors for septic patients. The area under the receiver operator characteristic curve was 0. 868 and 0.930. The sensitivity of prognostic evaluation was 81.1% and specificity was 74.5% with sTREM-1 50 ng/L, and the sensitivity was 83. 8% and specificity was 86. 3% with APACHE Ⅱ score 20 to estimate the outcome. Conclusion The serum sTREM-1 are elevated at early stage in sepsis patients. It can reflect the severity of the condition. The sTREM-1 level, which might be considered as a potential prognostic factor for septic patients, is significantly correlated with APACHE Ⅱ score.     

血清可溶性髓系细胞触发受体-1检测在细菌性肺炎诊断中的意义

目的:检测细菌性肺炎患者外周血可溶性髓系细胞触发受体-1(sTREM-1)的水平,观察sTREM-1对诊断细菌性肺炎的意义。方法:应用双抗体夹心酶联免疫吸附法(ELISA)检测75例细菌性肺炎患者及72例正常健康体检者血清sTREM-1、降钙素原(PCT)、C反应蛋白(CRP)的水平。应用受试者工作特征(ROC)曲线研究sTREM-1的诊断效力。对肺炎组进一步进行亚组分析,并将sTREM-1水平与临床肺部感染评分(CPIS)进行相关性分析。结果:细菌性肺炎患者血清sTREM-1水平为(9.89±6.13)ng/mL,较对照组[(3.37±1.67)ng/mL]显著升高(P=0.001)。根据ROC曲线,sTREM-1取>4.46ng/mL为临界值,其曲线下面积为0.811,诊断细菌性肺炎的灵敏度为70.7%,特异度为76.4%,阳性预测值为75.7%,阴性预测值为71.4%,准确率为73.5%,诊断效能中等。肺炎组中重症肺炎患者血清sTREM-1为(12.65±6.37)ng/mL,较非重症患者[(9.14±5.91)ng/mL]水平增高,差异有统计学意义(P<0.05)。肺炎组患者sTREM-1水平与CPIS评分呈正相关(P<0.05)。结论:测定细菌性肺炎患者血清sTREM-1水平对于细菌性肺炎的诊断有一定价值。重症肺炎患者血清sTREM-1水平升高,且与CPIS评分相关,提示sTREM-1与感染严重程度相关。     

A soluble form of the triggering receptor expressed on myeloid cells-1 modulates the inflammatory response in murine sepsis

The triggering receptor expressed on myeloid cells (TREM)-1 is a recently discovered receptor expressed on the surface of neutrophils and a subset of monocytes. Engagement of TREM-1 has been reported to trigger the synthesis of proinflammatory cytokines in the presence of microbial products. Previously, we have identified a soluble form of TREM-1 (sTREM-1) and observed significant levels in serum samples from septic shock patients but not controls. Here, we investigated its putative role in the modulation of inflammation during sepsis. We observed that sTREM-1 was secreted by monocytes activated in vitro by LPS and in the serum of animals involved in an experimental model of septic shock. Both in vitro and in vivo, a synthetic peptide mimicking a short highly conserved domain of sTREM-1 appeared to attenuate cytokine production by human monocytes and protect septic animals from hyper-responsiveness and death. This peptide seemed to be efficient not only in preventing but also in down-modulating the deleterious effects of proinflammatory cytokines. These data suggest that in vivo modulation of TREM-1 by sTREM peptide might be a suitable therapeutic tool for the treatment of sepsis.     

可溶性髓系细胞触发受体-1对呼吸机相关肺炎早期诊断及预后的判断价值

目的探讨血清及呼出气冷凝液（EVC）中可溶性髓系细胞触发受体-1（sTREM1）对呼吸机相关性肺炎（VAP）早期诊断及预后判断的临床价值。方法对37例机械通气患者进行治疗后评估,分成非感染组13例,感染组24例（其中治疗有效组14例,治疗无效组10例）,所有患者均在机械通气后第1、3、5、7天应用双抗体夹心酶联免疫吸附法（DAS-ELISA）测定血清和EVC中sTREM-1水平,并记录下呼吸道分泌物细菌培养结果和患者治疗后转归;应用受试者工作特征曲线（ROC）研究sTREM-1对VAP早期诊断效能及预后判断价值。结果第1天,血清及EVC中sTREM-1水平治疗有效组、治疗无效组及非感染组比较,差异无统计学意义（P〉0．05）;第3天和第5天,感染组较非感染组有明显升高（P〈（J．01）;第7天,治疗无效组仍处较高水平,与治疗有效组、非感染组比较差异有统计学意义（P〈0．01）,而治疗有效组与非感染组比较差异无统计学意义（P〉0．05）。应用ROC分析,第3天血清和EVC中sTREM-1曲线下面积分别为0．897、0．909。以第3天EVC中sTREM-14．70ng／mL为VAP的早期诊断界值,其诊断灵敏度为95．8％,特异度为92．3％。结论血清和EVC中sTREM-1检测有助于VAP的早期诊断,第7天血清和EVC中sTREM-1水平有助于判断VAP的预后（撤机失败和死亡）,与血清标本比较,EVC的获得更加方便。     

可溶性髓样细胞触发受体-1对脓毒血症早期诊断价值

目的探讨可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)对脓毒血症的早期诊断价值。方法 81例全身炎症反应综合征患者,根据脓毒血症诊断标准分为脓毒血症组35例与SIRS组46例,选择体检健康者30名为对照组,检测3组血清sTREM-1、降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)水平。结果脓毒血症组与SIRS组患者血清sTREM-1,PCT及CRP水平均高于对照组(P<0.05);脓毒血症组血清sTREM-1与PCT水平高于SIRS组(P<0.05),CRP水平与SIRS组比较差异无统计学意义(P>0.05)。结论血清sTREM-1是脓毒血症早期诊断的辅助指标,其灵敏度和特异性高于PCT和CRP。     

血浆可溶性髓样细胞触发受体1对成人脓毒症患者诊断价值的Meta分析

目的评价血浆可溶性髓样细胞触发受体1（sTREM-1）对成人脓毒症患者的诊断价值。 方法检索PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库和中文科技期刊全文库（VIP）数据库从建库至2017年5月发表的有关血浆sTREM-1对成人脓毒症患者诊断价值的文献。采用双变量模型计算合并诊断比值比（DOR）、合并敏感度、合并特异度、合并阳性似然比（PLR）及合并阴性似然比（NLR）。进行合并受试者工作特征（SROC）曲线，获得曲线下面积（AUC）。 结果最终纳入30篇文献，共3 349例患者。Meta分析显示，合并DOR为20.03[95%置信区间（CI）（12.20，32.87）]、合并敏感度为0.82[95% CI（0.77，0.86）]、合并特异度为0.81 [95% CI（0.76，0.85）]、合并PLR为4.36 [95% CI（3.37，5.64）]、合并NLR为0.22[95%CI（0.16，0.29）]。SROC曲线显示合并AUC为0.89[95%CI（0.85，0.91）]。 结论血浆sTREM-1对诊断成人脓毒症患者具有中度诊断价值。     

可溶性髓细胞触发受体-1对伴肺部渗出脓毒症患者的临床价值

目的检测新入ICU患者血清和肺泡灌洗液可溶性髓细胞触发受体-1（sTREM-1）,探讨sTREM-1在伴肺部渗出的脓毒症（ sepsis ）患者中的变化及意义。方法选择我院ICU 2012-09～2013-09收治的伴有肺部渗出及全身炎症反应综合征（ SIRS）的机械通气患者70例作为试验组,根据其临床特点及病原学检测结果,分为脓毒症组39例,非感染性SIRS组31例。两组在入院的第1、4、7天和第1、4天分别收集血清和肺泡灌洗液（ BALF）标本,同期纳入血清对照组30例,BALF对照组35例。采用酶联免疫吸附试验（ELISA）测定sTREM-1质量浓度,比较不同部位sTREM-1质量浓度与同期检测各种生物标志物对脓毒症的诊断及预后判断参数。结果①入院第1天脓毒症组血清sTREM-1质量浓度[425.20（653．72）pg/mL],与血清对照组（84.33±24．03）pg/mL及SIRS组[99．74（67．54）pg/mL]比较差异均有统计学意义（P＜0．01）;②入院第1天区分脓毒症与SIRS诊断的各参数ROC曲线下面积（ AUC）依次为血清sTREM-1（0．796）、CRP（0．668）,而入院第4天两组比较仅血清 sTREM -1差异有统计学意义（P ＝0.001）,其AUC为0．837;③各时间点脓毒症死亡组血清sTREM-1质量浓度均显著高于生存组（P＜0．05）,其中入院第1天判断脓毒症组预后各参数AUC依次为血清sTREM-1（0．792）、SOFA评分（0．756）;入院第4天依次为 SOFA 评分（0．801）、APACHEⅡ评分（0．757）、血清sTREM-1（0．696）;入院第7天依次为APACHEⅡ评分（0．835）、血清sTREM-1（0．725）;④入院第1、4及7天脓毒症生存组肺泡灌洗液sTREM-1质量浓度分别为（99．22±129．94,204．67±147．42,169．51±157．04）pg/mL,差异有统计学意义（P＝0．001）,而脓毒症死亡组不同时间点间比较差异无统计学意义（P＞0．05）。结论血清sTREM-1在伴有肺部渗出的脓毒症患者中呈高表达,显著高于SIRS患者及健康人群,其在脓毒症早期具有优于其他标志物的诊断与判断预后的能力,且肺泡灌洗液sTREM-1在病程后期下降,提示预后良好。