血清PCT及sTREM-1在肺癌术后并发细菌性肺部感染的诊断价值
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摘要
目的探讨血清降钙素原(PCT)与髓样细胞触发受体-1(sTREM-1)对肺癌患者手术后并发细菌性肺部感染的诊断价值。方法选择医院2014年5月-2017年10月行手术治疗的214例肺癌患者为研究对象,按照患者是否在手术后出现肺部感染分为感染组与未感染组,对两组患者手术后24h血清C-反应蛋白(CRP)、乳酸、PCT和sTREM-1水平进行比较。ROC曲线分析4种指标对于患者手术后24h发生肺部感染的诊断价值。按照感染组患者治疗后是否出现好转分为好转组与未好转组,比较手术后24h(T1),出现感染时(T2)和感染后48h(T3)患者CRP、乳酸、PCT和sTREM-1水平变化。结果感染组患者手术后24h血清CRP、乳酸、PCT和sTREM-1水平均高于未感染组(P<0.05);PCT和sTREM-1指标的曲线下面积为0.884和0.971,诊断价值优于CRP和乳酸;好转组患者经过治疗后48h,CRP、乳酸、PCT和sTREM-1水平均出现降低,未好转组经过治疗后48h,CRP、乳酸、PCT和sTREM-1水平均持续增高。结论肺癌患者术后发生细菌性肺部感染的概率较高,降钙素原与髓样细胞触发受体-1对肺部感染的诊断价值较高。
OBJECTIVE To explore the value of serum procalcitonin(PCT)and soluble triggering receptor expressed on myeloid cells(sTREM-1)in diagnosis of postoperative bacterial pulmonary infection in lung cancer patients.METHODS A total of 214 lung cancer patients who received surgical procedures in hospitals from May 2014 to Oct 2017 were recruited as the study objects and divided into the infection group and the non-infection group according to the status of postoperative pulmonary infection.The levels of serum C-reactive protein(CRP),lactic acid,PCT and sTREM-1 were compared between the two groups of patients after the surgery for 24 hours,ROC curve analysis was carried out for the value of the 4 types of indexes in diagnosis of the pulmonary infection after the surgery for 24 hours.The patients of the infection group were divided into the improved group and the unimproved group according to the treatment outcomes,and the levels of CRP,lactic acid,PCT and sTREM-1 were observed and compared after the surgery for 24 hours(T1),when the patients had the infection(T2)and after the patients had the infection for 48 hours(T3).RESULTS The levels of serum CRP,lactic acid,PCT and sTREM-1 of the infection group were significantly higher than those of the non-infection group after the surgery for 24 hours(P<0.05),the areas under the curve of PCT and sTREM-1 were 0.884 and 0.971,respectively,and the diagnostic value of PCT and sTREM-1 was higher than that of CRP and lactic acid.The levels of CRP,lactic acid,PCT and sTREM-1 of the improved group were reduced after the treatment for 48 hours,while the levels of CRP,lactic acid,PCT and sTREM-1 of the unimproved group were continuously elevated after the treatment for 48 hours.CONCLUSION The incidence of postoperative bacterial pulmonary infection is high in the lung cancer patients,and the PCT and sTREM-1 have high value in diagnosis of the pulmonary infection.
OBJECTIVE To explore the value of serum procalcitonin(PCT)and soluble triggering receptor expressed on myeloid cells(sTREM-1)in diagnosis of postoperative bacterial pulmonary infection in lung cancer patients.METHODS A total of 214 lung cancer patients who received surgical procedures in hospitals from May 2014 to Oct 2017 were recruited as the study objects and divided into the infection group and the non-infection group according to the status of postoperative pulmonary infection.The levels of serum C-reactive protein(CRP),lactic acid,PCT and sTREM-1 were compared between the two groups of patients after the surgery for 24 hours,ROC curve analysis was carried out for the value of the 4 types of indexes in diagnosis of the pulmonary infection after the surgery for 24 hours.The patients of the infection group were divided into the improved group and the unimproved group according to the treatment outcomes,and the levels of CRP,lactic acid,PCT and sTREM-1 were observed and compared after the surgery for 24 hours(T1),when the patients had the infection(T2)and after the patients had the infection for 48 hours(T3).RESULTS The levels of serum CRP,lactic acid,PCT and sTREM-1 of the infection group were significantly higher than those of the non-infection group after the surgery for 24 hours(P<0.05),the areas under the curve of PCT and sTREM-1 were 0.884 and 0.971,respectively,and the diagnostic value of PCT and sTREM-1 was higher than that of CRP and lactic acid.The levels of CRP,lactic acid,PCT and sTREM-1 of the improved group were reduced after the treatment for 48 hours,while the levels of CRP,lactic acid,PCT and sTREM-1 of the unimproved group were continuously elevated after the treatment for 48 hours.CONCLUSION The incidence of postoperative bacterial pulmonary infection is high in the lung cancer patients,and the PCT and sTREM-1 have high value in diagnosis of the pulmonary infection.
引文
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[14]田斌.老年重型颅脑损伤合并肺部感染患者血清CRP、PCT水平及意义[J].山东医药,2016,56(28):91-93.
[15]Edwards CL,Zhang V,Werder RB,et al.Coinfection with blood-stage plasmodium promotes systemic type I interferon production during pneumovirus infection but impairs inflammation and viral control in the lung[J].Clin Vaccine Immunol,2015,22(5):477-483.
[16]Chen TJ,Gao F,Feng SF,et al.MicroRNA-370inhibits the progression of non-small cell lung cancer by downregulating oncogene TRAF4[J].Oncol Rep,2015,34(1):461-468.
[17]王光权,李翠.两种肾脏替代疗法治疗老年乳酸酸中毒患者的疗效比较[J].中国老年学杂志,2017,37(2):448-449,450.
[18]李雯,任珊,姜利,等.何种乳酸指标更能有效预测高乳酸血症感染性休克患者14d病死率[J].首都医科大学学报,2018,39(1):9-13.
[19]Wu Y,Wang F,Fan X,et al.Accuracy of plasma sTREM-1for sepsis diagnosis in systemic inflammatory patients:a systematic review and meta-analysis[J].Crit Care,2012,16(6):R229.
[20]黄浩,陈湘平,陈凤朱,等.细菌性血流感染患者炎症因子的对比分析[J].国际呼吸杂志,2017,37(3):173-177.
[21]夏奇奂,齐福权.头孢美唑对老年肺部感染患者sTREM-1及TNF-α、IL-10水平的影响[J].中国老年学杂志,2018,38(2):391-392.
[22]Rohini SB,Srikumar A,Mahesh K,et al.Serum PCT and its relation to body weight gain in pulmonary tuberculosis[J].Indian J Clin Biochem,2015,30(3):329-333.
[23]郭玉梅,李政霖,祁恒旭,等.血必净注射液治疗对晚期肺癌合并肺部感染患者血清炎性因子水平的影响[J].中国医药导报,2016,13(32):125-128.
[24]Voudris KV,Chanin J,Feldman DN,et al.Novel inflammatory biomarkers in coronary artery disease:potential therapeutic approaches[J].Curr Med Chem,2015,22(22):2680-2689.
[25]Dhillon S,Yu XY,Cheypesh A,et al.Comparison of profiles of perioperative serum C-reactive protein levels in neonates undergoing the norwood procedure or arterial switch operation[J].Congenit Heart Dis,2015,10(3):226-233.
[2]Susanti I,Michael B.New cancer or carcinoid progression to small cell lung cancer?[J].J Bronchology Interv Pulmonol,2015,22(2):186-188.
[3]Kim DH,Jung JH,Son SH,et al.Prognostic significance of intratumoral metabolic heterogeneity on F-18-FDG PET/CT in pathological N0non-small cell lung cancer[J].Clin Nucl Med,2015,40(9):708-714.
[4]Sakamoto A,Matsumaru T,Yamamura N,et al.Drug transporter protein quantification of immortalized human lung cell lines derived from tracheobronchial epithelial cells(Calu-3and BEAS2-B),bronchiolar-alveolar cells(NCI-H292and NCI-H441),and alveolar type II-like cells(A549)by liquid chromatography-tandem mass spectrometry[J].J Pharm Sci,2015,104(9):3029-3038.
[5]杨铮雯,白桂红,邵润霞,等.肺癌患者血清降钙素原和白细胞介素-6水平与凝血指标的相关性[J].广东医学,2017,38(2):237-240.
[6]Wang H,Li WY,Lai BT,et al.A better experimental method to detect the sensitivity of cancer cells to anticancer drugs after adenovirus-mediated introduction of two kinds of p53in vivo[J].Anticancer Drugs,2015,26(8):852-859.
[7]Cimen D,Bulcun E,Ekici A,et al.Case of round pneumonia:pulmonary infarct and a rare situation that is similar with the lung cancer[J].Clin Respir J,2015,9(4):512-515.
[8]肖朗,刘慧敏.血清IL-6、hs-CRP及pct水平检测在重症手足口病合并细菌性脑炎诊断中的价值[J].世界临床药物,2016,37(8):535-538.
[9]Garcia de Guadiana-Romualdo L,Espanol-Morales I,Cerezuela-Fuentes P,et al.Value of lipopolysaccharide binding protein as diagnostic marker of infection in adult cancer patients with febrile neutropenia:comparison with C-reactive protein,procalcitonin,and interleukin 6[J].Support Care Cancer,2015,23(7):2175-2182.
[10]范春红,范惠群,邓洁瑜,等.可溶性髓样细胞触发受体1和可溶性血红蛋白清道夫受体检测在重症肺炎的临床意义[J].中国现代医生,2015,53(24):25-27.
[11]Huang CT,Lee LN,Ho CC,et al.High serum levels of procalcitonin and soluble TREM-1correlated with poor prognosis in pulmonary tuberculosis[J].J Infect,2014,68(5):440-447.
[12]Ruiz-Pacheco JA,Vivanco-Cid H,Izaguirre-Hernandez IY,et al.TREM-1modulation during early stages of dengue virus infection[J].Immuno Let,2014,158(1/2):183-188.
[13]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[14]田斌.老年重型颅脑损伤合并肺部感染患者血清CRP、PCT水平及意义[J].山东医药,2016,56(28):91-93.
[15]Edwards CL,Zhang V,Werder RB,et al.Coinfection with blood-stage plasmodium promotes systemic type I interferon production during pneumovirus infection but impairs inflammation and viral control in the lung[J].Clin Vaccine Immunol,2015,22(5):477-483.
[16]Chen TJ,Gao F,Feng SF,et al.MicroRNA-370inhibits the progression of non-small cell lung cancer by downregulating oncogene TRAF4[J].Oncol Rep,2015,34(1):461-468.
[17]王光权,李翠.两种肾脏替代疗法治疗老年乳酸酸中毒患者的疗效比较[J].中国老年学杂志,2017,37(2):448-449,450.
[18]李雯,任珊,姜利,等.何种乳酸指标更能有效预测高乳酸血症感染性休克患者14d病死率[J].首都医科大学学报,2018,39(1):9-13.
[19]Wu Y,Wang F,Fan X,et al.Accuracy of plasma sTREM-1for sepsis diagnosis in systemic inflammatory patients:a systematic review and meta-analysis[J].Crit Care,2012,16(6):R229.
[20]黄浩,陈湘平,陈凤朱,等.细菌性血流感染患者炎症因子的对比分析[J].国际呼吸杂志,2017,37(3):173-177.
[21]夏奇奂,齐福权.头孢美唑对老年肺部感染患者sTREM-1及TNF-α、IL-10水平的影响[J].中国老年学杂志,2018,38(2):391-392.
[22]Rohini SB,Srikumar A,Mahesh K,et al.Serum PCT and its relation to body weight gain in pulmonary tuberculosis[J].Indian J Clin Biochem,2015,30(3):329-333.
[23]郭玉梅,李政霖,祁恒旭,等.血必净注射液治疗对晚期肺癌合并肺部感染患者血清炎性因子水平的影响[J].中国医药导报,2016,13(32):125-128.
[24]Voudris KV,Chanin J,Feldman DN,et al.Novel inflammatory biomarkers in coronary artery disease:potential therapeutic approaches[J].Curr Med Chem,2015,22(22):2680-2689.
[25]Dhillon S,Yu XY,Cheypesh A,et al.Comparison of profiles of perioperative serum C-reactive protein levels in neonates undergoing the norwood procedure or arterial switch operation[J].Congenit Heart Dis,2015,10(3):226-233.