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降钙素原、髓系细胞表达的触发受体-1联合临床肺部感染评分对呼吸机相关性肺炎的早期诊断价值
作者:张晓勤1 2  黎嘉嘉2  刘池2  程德云1 
单位:1. 四川大学华西医院, 四川 成都 610041;
2. 四川省医学科学院·四川省人民医院, 四川 成都 610072
关键词:降钙素原 髓系细胞表达的触发受体-1 临床肺部感染评分 呼吸机相关性肺炎 早期诊断 
分类号:R563.1;R560.4
出版年·卷·期(页码):2015·34·第四期(605-608)
摘要:

目的:探讨降钙素原(PCT)、髓系细胞表达的触发受体-1(TREM-1)联合临床肺部感染评分(CPIS)对呼吸机相关性肺炎(VAP)早期诊断的临床意义。方法:采用前瞻性观察性研究方法,以78例有创机械通气患者为研究对象,所有患者均在机械通气后第1、3、7天采集外周血及肺泡灌洗液标本并进行检测,同时进行CPIS,根据治疗后评估,将78例患者分为VAP确诊组(45例)与非VAP确诊组(33例),应用ROC曲线评价PCT、TREM-1、CPIS联合指标对VAP的早期诊断价值。结果:两组的PCT、TREM-1、CPIS差异有统计学意义(P<0.01)。第3天联合指标的诊断效能最高,PCT、TREM-1、CPIS联合指标对诊断VAP的敏感性、特异性、阳性预测值、阴性预测值分别为80.4%、100.0%、93.5%、100.0%。结论:结合PCT、TREM-1、CPIS综合分析可以显著提高诊断的特异性,对VAP的早期诊断有较好的实用性。

Objective: To explore the clinical value of the combination of procalcitonin(PCT) and triggering receptor expressed on myeloid cells-1(TREM-1) and clinical pulmonary infection score(CPIS) in the early diagnosis of ventilator-associated pneumonia(VAP). Methods: A prospective observational study was conducted. A total of 78 patients with mechanical ventilation treatment were recruited and the levels of PCT and TREM-1 and CPIS were detected or evaluated on the first day, third day and seventh day of the end of treatment. All subjects were divided into VAP group (45 cases) and Non-VAP group (33 cases). The early diagnostic value was assessed by ROC curve analysis. Results: The PCT and TREM-1 and CPIS showed significant differences between the VAP group and Non-VAP group (all P<0.01). The ROC results showed that the sensitivity, specificity, positive predictive rates, negative predictive rates of the combination index of PCT and TREM-1 and CPIS were 80.4%, 100.0%, 93.5%, 100.0%. Conclusion: The combination index of PCT and TREM-1 and CPIS can significantly improve the specificity of the early diagnosis of VAP, which means that the combination index is practical in diagnosing VAP.

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