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中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 307 -312. doi: 10.3877/cma.j.issn.1674-1358.2022.05.004

论著

新型生物标志物可溶性髓样细胞触发受体-1在重症肺炎早期诊断中的应用价值
贺雨1, 王玉娟2, 高蓉1, 李晗1, 胡长英1, 杨俊玲1,†()   
  1. 1. 130041　长春市，吉林大学第二医院呼吸与危重症医学科
    2. 710000　西安市，西安交通大学第二附属医院呼吸与危重症医学科
  • 收稿日期:2021-10-20 出版日期:2022-10-15
  • 通信作者: 杨俊玲
  • 基金资助:
    吉林省财政厅卫生专项项目(No. 2020SC2T005); 吴阶平医学基金会临床科研专项资助基金项目(No. 320.6750.2021-23-23)

Clinical value of a new biomarker serum soluble myeloid cell triggered receptor-1 in early diagnosis of severe pneumonia

Yu He1, Yujuan Wang2, Rong Gao1, Han Li1, Changying Hu1, Junling Yang1,†()   

  1. 1. Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, China
    2. Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, China
  • Received:2021-10-20 Published:2022-10-15
  • Corresponding author: Junling Yang
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引用本文：

贺雨, 王玉娟, 高蓉, 李晗, 胡长英, 杨俊玲. 新型生物标志物可溶性髓样细胞触发受体-1在重症肺炎早期诊断中的应用价值[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(05): 307-312.

Yu He, Yujuan Wang, Rong Gao, Han Li, Changying Hu, Junling Yang. Clinical value of a new biomarker serum soluble myeloid cell triggered receptor-1 in early diagnosis of severe pneumonia[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(05): 307-312.

目的

探究血清可溶性髓样细胞触发受体-1（sTREM-1）在重症肺炎早期诊断中的应用价值。

方法

2021年6月到2021年12月于吉林大学第二医院就诊的60例肺炎患者纳入研究组，其中重症40例（重症肺炎组）和轻症20例（普通肺炎组）。以及同期门诊体检者15例纳入健康对照组。研究组患者均于入院24 h内使用肺炎严重程度指数（PSI）评分进行评估；分别采用电化学发光法、散射比浊法、酶联免疫吸附实验（ELISA）检测血清降钙素原（PCT）、超敏C-反应蛋白（hs-CRP）和sTREM-1水平。比较重症肺炎组、普通肺炎组及健康对照组研究对象入组24 h内血清sTREM-1水平，并比较重症肺炎组和普通肺炎组研究对象入组24 h内血清PCT、hs-CRP水平及PSI评分。采用Pearson相关性分析探讨血清sTREM-1和hs-CRP水平与PSI评分的相关性；采用Spearson相关性探讨血清PCT水平与PSI评分的相关性。绘制受试者工作特征曲线（ROC）及应用MedCalc软件比较曲线下面积（AUC）比较血清sTREM-1、PCT和hs-CRP对重症肺炎早期诊断的价值。

结果

重症肺炎组、普通肺炎组以及健康对照组血清sTREM-1表达水平（4 864.81 ± 1 314.53 pg/ml、1 144.58 ± 571.01 pg/ml、509.11 ± 43.70 pg/ml）差异有统计学意义（F = 109.292、P < 0.001），其中重症肺炎组较普通肺炎组和健康对照组显著升高（t = 10.981、P < 0.001，t = 9.264、P < 0.001）。重症肺炎组患者血清PCT、hs-CRP水平以及PSI评分均高于普通肺炎组，差异有统计学意义（Z =－3.360、P = 0.001，t = 2.047、P = 0.048，t = 4.878、P < 0.001）。血清sTREM-1、PCT和hs-CRP诊断重症肺炎的AUC分别为1.00、0.86和0.68（95%CI：1.00~1.00、0.73~0.98、0.51~0.86）；分别以2 916.92 pg/ml、0.31 ng/ml和32.14 mg/L为截断值时约登指数最大，对应的敏感性分别为100%、85%和85%，特异性分别为100%、81%和50%。sTREM-1诊断重症肺炎的AUC与hs-CRP、PCT差异均有统计学意义（Z = 3.463、P < 0.001，Z = 2.220、P = 0.026）；hs-CRP与PCT差异无统计学意义（Z = 1.454、P = 0.146）。PSI评分与血清sTREM-1（r = 0.641、P < 0.001）、PCT（r = 0.540、P = 0.001）呈正相关，与血清hs-CRP无相关性（r = 0.269、P = 0.124）。

结论

肺炎患者血清sTREM-1升高，以重症患者升高更为显著，且其与PSI评分呈正相关；检测血清sTREM-1水平有助于早期诊断重症肺炎，且其特异性及敏感性高，均优于PCT和hs-CRP，有望成为新的早期诊断重症肺炎的生物标志物。

关键词: 可溶性髓样细胞触发受体-1, 重症肺炎, 早期诊断, 降钙素原, 超敏C-反应蛋白
Objective

To investigate the value of serum soluble myeloid cell triggered receptor-1 (sTREM-1) in the early diagnosis of severe pneumonia.

Methods

Total of 60 patients with pneumonia who were treated in The Second Hospital of Jilin University from June 2021 to December 2021 were incorporated in study group, including 40 severe cases (severe pneumonia group) and 20 mild cases (common pneumonia group). Another 15 physical examiner during the same period were selected as control group. All patients in study group were evaluated by the pneumonia severity index (PSI) score within 24 hours after admission. The immunoscattering turbidimetry, electrochemical luminescence and enzyme-linked immunosorbent assay (ELISA) were used to detect the levels of serum procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP) and sTREM-1, respectively. The levels of serum sTREM-1 in severe pneumonia group, common pneumonia group and control group within admission 24 hours were compared, and the levels of PCT, hs-CRP and PSI score in severe and common pneumonia group within admission 24 hours were compared, respectively. The correlation between serum sTREM-1 and hs-CRP and PSI score were analyzed by Pearson correlation analysis; the correlation between serum PCT and PSI score were analyzed by Spearson correlation analysis. The value of serum sTREM-1, PCT and hs-CRP in the early diagnosis of severe pneumonia were compared by the area under receiver operating characteristic curve (ROC) by MedCalc software.

Results

The levels of serum sTREM-1 in severe pneumonia group, common pneumonia group and healthy control group (4 864.81 ± 1 314.53 pg/ml, 1 144.58 ± 571.01 pg/ml, 509.11 ± 43.70 pg/ml) were significantly different (F = 109.292, P < 0.001), and the levels of serum sTREM-1 of severe pneumonia group was significantly higher than those of common pneumonia group and control group (t = 10.981, P < 0.001; t = 9.264, P < 0.001). The levels of serum PCT, hs-CRP and PSI score in severe pneumonia group were significantly higher than those in common pneumonia group (Z =-3.360, P = 0.001; t = 2.047, P = 0.048; t = 4.878, P < 0.001). The AUCs of serum sTREM-1, PCT and hs-CRP for diagnosis of severe pneumonia were 1.00, 0.86 and 0.68, respectively (95%CI: 1.0-1.00, 0.73-0.98, 0.51-0.86). When 2 916.92 pg/ml, 0.31 ng/ml and 32.14 mg/L were selected as the Cut-off values, respectively, Youden index was highest; the corresponding sensitivity were 100%, 85% and 85%, while the specificity were 100%, 81% and 50%, respectively. The AUC of sTREM-1 for diagnosis of severe pneumonia was significantly different from those of hs-CRP and PCT (Z = 3.463, P < 0.001; Z = 2.220, P = 0.026). And there was no significant difference between hs-CRP and PCT (Z = 1.454, P = 0.146). The PSI score was positively correlated with the serum sTREM-1 (r = 0.641, P < 0.001) and PCT (r = 0.540, P = 0.001). However, there was no correlation between PSI score and serum hs-CRP (r = 0.269, P = 0.124).

Conclusions

The level of serum sTREM-1 increased in pneumonia, especially in severe cases, which is positively correlated with PSI score. The detection of serum sTREM-1 is valuable for the early diagnosis of severe pneumonia, and its specificity and sensitivity are higher than those of PCT and hs-CRP. It is expected to become a new biomarker for early diagnosis of severe pneumonia.

Key words: Soluble myeloid cell trigger receptor-1, Severe pneumonia, Early diagnosis, Procalcitonin, Hypersensitive C-reactive protein
表1 重症肺炎组和普通肺炎组患者的一般特征
指标 重症肺炎组（40例） 普通肺炎组（20例） 统计量 P值
性别[例（%）]     χ2 = 0.13 0.714
  男 22（55.0） 10（50.0）    
  女 18（45.0） 10（50.0）    
年龄（± s，岁） 67 ± 14 64 ± 5 t = 0.88 0.385
死亡[例（%）] 15（37.5） 0（0.0） χ2 = 10.00 0.002
辅助通气[例（%）]     χ2 = 20.00 < 0.001
  有创 24（60.0） 0（0.0）    
  无创 16（40.0） 20（100.0）    
实验室指标（± s）        
  PaO2/FiO2 185 ± 67 368 ± 71 t = 7.74 < 0.001
  白细胞计数（× 109/L） 15.96 ± 8.25 8.18 ± 2.56 t = 3.53 < 0.001
PSI评分分级[例（%）]     χ2 = 16.51 < 0.001
  Ⅰ级 0（0.0） 2（10.0）    
  Ⅱ~Ⅲ级 13（32.5） 15（75.0）    
  Ⅳ~Ⅴ级 27（67.5） 3（15.0）    
表2 各组研究对象血清指标和PSI评分
组别 例数 sTREM-1（± s，pg/ml） PCT [M（P25，P75），ng/ml] hs-CRP（± s，mg/L） PSI评分（± s，分）
健康对照组 15 509.11 ± 43.70 — — —
普通肺炎组 20 1 144.58 ± 571.01 1.42（0.54，6.22） 31.54 ± 22.97 77 ± 20
重症肺炎组 40 4 864.81 ± 1 314.53 0.19（0.06，0.41） 46.50 ± 19.59 134 ± 39
统计量   F = 109.292 Z=－3.360 t = 2.047 t = 4.878
P值   < 0.001 0.001 0.048 < 0.001
表3 血清sTREM-1、PCT和hs-CRP诊断重症肺炎的ROC曲线分析
指标 AUC 最佳阈值 敏感性（%） 特异性（%） 95%CI
sTREM-1 1.00 2 916.92 pg/ml 100 100 1.00~1.00
PCT 0.86 0.31 ng/ml 85 81 0.73~0.98
hs-CRP 0.68 32.14 mg/L 85 50 0.51~0.86
图1 血清sTREM-1、PCT和hs-CRP诊断重症肺炎的ROC曲线
图2 PSI评分与血清PCT、hs-CRP和sTREM-1的相关性注：A：PSI评分与PCT相关性；B：PSI评分与hs-CRP相关性；C：PSI评分与sTREM-1相关性
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