外周血PCT、IL-17、sTREM-1檢測在呼吸機相關(guān)性肺炎診斷中的價值
發(fā)布時間：2018-11-27 18:39
【摘要】：目的:觀測機械通氣并發(fā)生呼吸機相關(guān)性肺炎(VAP)患者外周血中PCT、IL-17和s TREM-1濃度變化并探討PCT、IL-17、s TREM-1對VAP的診斷價值。方法:在蚌埠醫(yī)學(xué)院第一附屬醫(yī)院ICU 2015年4月-2016年4月期間,采集欲行呼吸機治療患者的外周靜脈血,此標本納入MV0h組;行呼吸機治療滿48小時,但明確診斷未并發(fā)VAP的患者,48小時時采集其外周靜脈血,此標本納入MV-NVAP組;行機械通氣滿48小時后,明確診斷并發(fā)VAP的患者,立即采集其外周靜脈血,此標本納入VAP組。每個患者觀察時間窗定為7天,7天內(nèi)未發(fā)生VAP的患者予以剔除。血清樣本均采用ELISA測定PCT、IL-17和s TREM-1濃度,數(shù)據(jù)采用SPSS18.0軟件進行統(tǒng)計學(xué)分析。結(jié)果:MV-NVAP組血清樣本中PCT、IL-17和s TREM-1水平均高于MV0h,P0.05,無統(tǒng)計學(xué)意義。VAP組血清樣本中PCT、IL-17和s TREM-1水平均高于MV0h、MV-NVAP組,P0.05,具有統(tǒng)計學(xué)意義。PCT的受試者工作曲線(ROC曲線)下面積為0.856,當血清中PCT水平達到104.7864pg/ml時,診斷VAP的靈敏度為73.9%,特異度為84.8%。IL-17的ROC曲線下面積為0.887,當血清中IL-17水平達到136.9726pg/ml時,診斷VAP的靈敏度為70.8%,特異度為91.7%。s TREM-1的ROC曲線下面積為0.813,當血清中s TREM-1水平達到95.4204pg/ml時,診斷VAP的靈敏度為72.4%,特異度為79.3%;聯(lián)合PCT、IL-17兩種指標診斷VAP的ROC曲線下面積為0.816,診斷靈敏度為78.7%,特異度為71.0%。聯(lián)合PCT、s TREM-1兩種指標診斷VAP的ROC曲線下面積為0.791,診斷靈敏度為82.0%,特異度為54.8%。聯(lián)合IL-17、s TREM-1兩種指標診斷VAP的ROC曲線下面積為0.812,診斷靈敏度為78.7%,特異度為71.0%。聯(lián)合PCT、IL-17、s TREM-1三種指標診斷VAP的ROC曲線下面積為0.973,診斷靈敏度為84.4%,特異度為90.6%。結(jié)論:行呼吸機支持治療48小時后,機械通氣所致的機械性損傷可能導(dǎo)致患者體內(nèi)PCT、IL-17、s TREM-1水平升高。聯(lián)合PCT、IL-17對VAP的診斷靈敏度較單一指標提高,但特異度略低。聯(lián)合PCT、s TREM-1對VAP的診斷靈敏度較單一指標明顯提高,但特異度較低。聯(lián)合IL-17、s TREM-1對VAP的診斷靈敏度較單一指標提高,但特異度略低。聯(lián)合PCT、IL-17、s TREM-1對VAP進行診斷,其診斷靈敏度較單一指標、兩兩聯(lián)合指標明顯提高,特異度較PCT、s TREM-1、兩兩聯(lián)合指標明顯提高,但較IL-17略低�；颊咄庵苎蠵CT、IL-17、s TREM-1水平對VAP均具有一定的輔助診斷價值。
[Abstract]:Objective: to observe the changes of PCT,IL-17 and s TREM-1 in peripheral blood of patients with mechanical ventilation and ventilator-associated pneumonia (VAP) and to explore the diagnostic value of PCT,IL-17,s TREM-1 in VAP. Methods: from April 2015 to April 2016, peripheral venous blood samples were collected from patients in the first affiliated Hospital of Bengbu Medical College from April 2015 to April 2016. The blood samples were included in the MV0h group. The peripheral venous blood was collected at 48 hours after ventilator treatment, but not complicated with VAP. The samples were included in MV-NVAP group. After 48 hours of mechanical ventilation, the patients with VAP were diagnosed and their peripheral venous blood was collected immediately. The samples were included in the VAP group. Each patient's observation window was set at 7 days and those without VAP within 7 days were excluded. The concentrations of PCT,IL-17 and s TREM-1 were measured by ELISA, and the data were analyzed by SPSS18.0 software. Results: the levels of PCT,IL-17 and s TREM-1 in serum samples of MV-NVAP group were higher than those in MV0h,P0.05, group, but the levels of PCT,IL-17 and s TREM-1 in VAP group were higher than those in MV0h,MV-NVAP group (P 0.05). The area under the operating curve (ROC curve) of PCT subjects was 0.856. When the serum PCT level reached 104.7864pg/ml, the sensitivity of diagnosing VAP was 73.9%. The area under the ROC curve with specificity of 84.8%.IL-17 was 0.887.When the level of IL-17 in serum reached 136.9726pg/ml, the sensitivity of diagnosis of VAP was 70.8. The area under the ROC curve with specificity of 91.7? s TREM-1 was 0.813. When the level of s TREM-1 in serum reached 95.4204pg/ml, the sensitivity and specificity of diagnosis of VAP were 72.4 and 79.3 respectively. The area under the ROC curve of VAP combined with PCT,IL-17 was 0.816, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,s TREM-1 was 0.791.The diagnostic sensitivity was 82.0 and the specificity was 54.8. The area under the ROC curve of VAP combined with IL-17,s TREM-1 was 0.812, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,IL-17,s TREM-1 was 0.973, the diagnostic sensitivity was 84.4 and the specificity was 90.6. Conclusion: mechanical injury induced by mechanical ventilation may lead to the increase of PCT,IL-17,s TREM-1 level in patients 48 hours after ventilator support therapy. The diagnostic sensitivity of combined PCT,IL-17 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity of combined PCT,s TREM-1 for VAP was significantly higher than that of single index, but the specificity was lower. The diagnostic sensitivity of combined IL-17,s TREM-1 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity and specificity of combined PCT,IL-17,s TREM-1 in diagnosis of VAP were significantly higher than that of single index, pairwise combination index and PCT,s TREM-1, combination index, but slightly lower than that of IL-17. The level of PCT,IL-17,s TREM-1 in peripheral blood of patients has some auxiliary diagnostic value for VAP.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.1
本文編號：2361699
[Abstract]:Objective: to observe the changes of PCT,IL-17 and s TREM-1 in peripheral blood of patients with mechanical ventilation and ventilator-associated pneumonia (VAP) and to explore the diagnostic value of PCT,IL-17,s TREM-1 in VAP. Methods: from April 2015 to April 2016, peripheral venous blood samples were collected from patients in the first affiliated Hospital of Bengbu Medical College from April 2015 to April 2016. The blood samples were included in the MV0h group. The peripheral venous blood was collected at 48 hours after ventilator treatment, but not complicated with VAP. The samples were included in MV-NVAP group. After 48 hours of mechanical ventilation, the patients with VAP were diagnosed and their peripheral venous blood was collected immediately. The samples were included in the VAP group. Each patient's observation window was set at 7 days and those without VAP within 7 days were excluded. The concentrations of PCT,IL-17 and s TREM-1 were measured by ELISA, and the data were analyzed by SPSS18.0 software. Results: the levels of PCT,IL-17 and s TREM-1 in serum samples of MV-NVAP group were higher than those in MV0h,P0.05, group, but the levels of PCT,IL-17 and s TREM-1 in VAP group were higher than those in MV0h,MV-NVAP group (P 0.05). The area under the operating curve (ROC curve) of PCT subjects was 0.856. When the serum PCT level reached 104.7864pg/ml, the sensitivity of diagnosing VAP was 73.9%. The area under the ROC curve with specificity of 84.8%.IL-17 was 0.887.When the level of IL-17 in serum reached 136.9726pg/ml, the sensitivity of diagnosis of VAP was 70.8. The area under the ROC curve with specificity of 91.7? s TREM-1 was 0.813. When the level of s TREM-1 in serum reached 95.4204pg/ml, the sensitivity and specificity of diagnosis of VAP were 72.4 and 79.3 respectively. The area under the ROC curve of VAP combined with PCT,IL-17 was 0.816, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,s TREM-1 was 0.791.The diagnostic sensitivity was 82.0 and the specificity was 54.8. The area under the ROC curve of VAP combined with IL-17,s TREM-1 was 0.812, the diagnostic sensitivity was 78.7, and the specificity was 71.0. The area under the ROC curve of VAP combined with PCT,IL-17,s TREM-1 was 0.973, the diagnostic sensitivity was 84.4 and the specificity was 90.6. Conclusion: mechanical injury induced by mechanical ventilation may lead to the increase of PCT,IL-17,s TREM-1 level in patients 48 hours after ventilator support therapy. The diagnostic sensitivity of combined PCT,IL-17 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity of combined PCT,s TREM-1 for VAP was significantly higher than that of single index, but the specificity was lower. The diagnostic sensitivity of combined IL-17,s TREM-1 for VAP was higher than that of single index, but the specificity was slightly lower. The diagnostic sensitivity and specificity of combined PCT,IL-17,s TREM-1 in diagnosis of VAP were significantly higher than that of single index, pairwise combination index and PCT,s TREM-1, combination index, but slightly lower than that of IL-17. The level of PCT,IL-17,s TREM-1 in peripheral blood of patients has some auxiliary diagnostic value for VAP.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.1
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