中国实用儿科杂志

中国实用儿科杂志

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可溶性髓细胞触发受体-1对3月龄以下婴儿细菌感染诊断价值研究

王晓颖，李    莉，李尔珍，米    荣，康利民，崔小岱， 呼守生   

  1. 首都儿科研究所附属儿童医院，北京  100020
  • 出版日期:2013-06-06 发布日期:2013-05-31
  • 通讯作者: 李莉

Soluble triggering receptor expressed on myeloid cells-1（sTREM-1） in the diagnosis of infectious diseases in infants aged less than 3 months.

WANG Xiao-ying，LI Li，LI Er-zhen，MI Rong，KANG Li-min，CUI Xiao-dai，HU Shou-sheng.   

  1. Children's Hospital affiliated to Capital Institute of Pediatrics，Beijing 100020，China
  • Online:2013-06-06 Published:2013-05-31

摘要：

摘要：目的    检测3月龄以下的细菌感染婴儿血清中可溶性髓细胞触发受体-1（sTREM-1），探讨sTREM-1在小婴儿细菌感染中的变化及其意义。方法    选择2010-01-01—2011-12-31期间在首都儿科研究所附属儿童医院住院治疗的、年龄7 d至3月龄的小婴儿患者共94例作为研究对象，根据其临床特点及病原学检测结果，分为细菌感染组32例、病毒感染组30例和无感染组32例。患儿均于入院后12 h内留取血清，细菌感染组尚分别于疾病恢复期和痊愈期留取血清，采用酶联免疫吸附试验测定血清中的sTREM-1水平，采用配对T检验及单因素方差分析进行组间比较，同时进行ROC曲线分析，比较各种炎症指标在细菌感染中的诊断参数。结果    （1）感染急性期细菌感染组血清中sTREM-1为（240.20 ± 120.25）pg/mL；与病毒感染组（81.26 ± 13.83）pg/mL和无感染组（69.42 ± 23.69）pg/mL比较，差异有统计学意义（P = 0.000）。病毒感染组较无感染组有轻度升高，但差异无统计学意义（P = 0.056）。（2）细菌感染组sTREM-1在恢复期及痊愈期分别为（118.92 ± 59.74）pg/mL 及（ 73.59 ± 35.49）pg/mL，其急性期、恢复期、痊愈期之间比较，差异均有统计学意义（P＜0.05）。（3）细菌感染组痊愈期（73.59 ± 35.49）pg/mL与无感染组（69.42 ± 23.69）pg/mL 比较，差异无统计学意义（P = 0.307）。（4）细菌感染组中革兰阳性细菌感染组 sTREM-1为（202.54 ± 107.14）pg/mL，与革兰阴性细菌感染组（210.36 ± 120.93）pg/mL比较，差异无统计学意义（P＞0.05）。（5）感染急性期血清中sTREM-1水平对区分细菌感染与病毒感染或非感染的ROC曲线下面积为0.983（95%CI 0.96～1.00 ），高于其他标志物C反应蛋白（CRP） 0.947（95%CI 0.883～1.01）、外周血白细胞（WBC） 0.747（95%CI0.631～0.864）、降钙素原（PCT） 0.950（95%CI0.907～0.994）。结论    3月龄以下婴儿细菌感染时血清中sTREM-1呈现高水平表达，显著高于病毒感染患儿及无感染患儿，随着感染被控制，sTREM-1呈下降趋势，其敏感度、特异度和PCT接近，但高于WBC计数和CRP。

关键词: 婴儿, 可溶性髓细胞触发受体-1, 细菌感染, 血清

Abstract:

Objective    To detect the serum  levels of soluble triggering receptor expressed on myeloid cells-1（sTREM-1）so as to investigate the significance of sTREM-1 in small infants with infectious diseases. Methods    All subjects were infants aged 7 d ~3 m hospitalized from January 1，2011 to December 31，2011.Ninety-four patients were enrolled .According to the results of the pathogens the patients were divided into three groups： 32 with bacterial infection， 30 with viral infection and 32 controls without infection. Blood samples were collected from the enrolled patients hospitalized in 12 hours .At convalescence  and  recovery time the blood samples were collected from the bacterial infection patients. Serum sTREM-1 was measured by ELISA（enzyme-linked immunosorbent assay）. The data were analyzed by Paired T test and Single factor analysis of variance. Results    The levels of serum sTREM-1 in acute phase in patients of three groups were as follows： the mean level was （240.20 ± 120.25）pg/mL in bacterial infection group， viral infection group （81.26 ± 13.83）pg/mL， no-infection group （69.42 ± 23.69）pg/mL. The bacterial infection  group had higher sTREM-1 level than viral infection group and no-infection group. The difference was of statistical significance. The viral infection group had higher sTREM-1 level than no-infection group. The difference was of no statistical significance. The levels of serum sTREM-1 in acute phase， convalescent phase， recovery phase were as follows： sTREM-1 level in acute phase（240.2 ± 120.25 pg/mL）was higher than convalescent and recovery phase（118.92 ± 59.74； 73.59 ± 35.49 pg/mL）.The difference was of statistical significance. The level of serum sTREM-1 in recovery phase in bacterial infection group was （73.59 ± 35.49 pg/ml），the level in no-infection group（69.42 ± 23.69 pg/mL）.The difference was of no statistical significance. The level of serum sTREM-1：Gram-positive bacterial infection（202.54 ± 107.14 pg/mL）and Gram-negative bacterial infection（210.36 ± 120.93 pg/mL），the difference was of no statistical significance. Serum level of sTREM - 1 to distinguish between bacterial infection and virus infection or are infected area under ROC curve for 0.983 （95% CI 0.96 1.00）， higher than other markers CRP 0.947 （95% CI0.883～1.01）， WBC 0.747 （95% CI0.631～0.864）， PCT 0.950 （95% CI0.907～0.994） .Conclusion    The sTREM-1 has high expression level in serum in infantile bacterial infection. The sTREM-1 is higher in bacterial infection group than that in viral infection group and no-infection group. The sTREM-1 declines with the recovery of the bacterial infection. There is significant difference according to the infection severity. This suggests it may be an index to bacterial infection diagnosis and evaluation of the severity of infection.

Key words:  , infant；soluble triggering receptor expressed on myeloid cells-1（sTREM-1）；bacterial infection；serum