血清sTREM-1联合SIRS评分对烧伤患者并发脓毒症的诊断效能

杨建华; 李雪; 刘浩

doi:10.16766/j.cnki.issn.1674-4152.002853

血清sTREM-1联合SIRS评分对烧伤患者并发脓毒症的诊断效能

doi: 10.16766/j.cnki.issn.1674-4152.002853

杨建华^1, ,,
李雪²,
刘浩³

1.
山东省立第三医院创伤手足与创面修复外科，山东济南 253500
2.
济南爱容整形医院整容整形科，山东济南 253500
3.
解放军第960医院烧伤整复外科，山东济南 253500

基金项目:

山东省医药卫生科技发展计划项目 2017WS1019

详细信息

通讯作者:
杨建华，E-mail: wwg_1025@126.com

中图分类号: R644 R631
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- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2022-01-29
- 网络出版日期: 2023-04-20

Efficacy of serum sTREM-1 combined with SIRS score in the diagnosis of sepsis in burn patients

YANG Jian-hua^{1
, ,},
LI Xue²,
LIU Hao³

1.
Hand Foot Trauma and Wound Repair Surgery, Shandong Provincial Third Hospital, Jinan, Shandong 253500, China

摘要

摘要: 目的探讨烧伤患者血清可溶性髓样细胞触发受体1(sTREM-1)及全身炎症反应综合征(SIRS)评分的变化，以及两指标对烧伤患者并发脓毒症的诊断价值。方法选择2019年3月—2020年10月山东省立第三医院收治的193例烧伤患者，其中局部感染65例(局部感染组)，合并脓毒症38例(脓毒症组)，单纯烧伤90例(单纯烧伤组)。检测血清sTREM-1水平，进行SIRS评分，采用受试者工作特征曲线(ROC)分析sTREM-1联合SIRS评分诊断烧伤并发脓毒症的价值。结果脓毒症组血清sTREM-1水平[(169.83±31.54)ng/mL、(124.05±24.09)ng/mL、(72.18±11.58)ng/mL]，SIRS评分[3.5(2.0, 4.0)分、1.5(1.0, 2.0)分、0.5(0, 1.0)分]高于局部感染组和单纯烧伤组(P＜0.05)，局部感染组血清sTREM-1水平、SIRS评分高于单纯烧伤组(P＜0.05)。Logistic回归分析结果显示，高水平sTREM-1(OR=2.003，95% CI：1.945~2.135)是烧伤患者合并脓毒症的危险因素(P＜0.05)。ROC分析结果显示sTREM-1、SIRS评分、联合sTREM-1和SIRS评分诊断烧伤患者合并脓毒症的曲线下面积(AUC)分别为0.731、0.629、0.943，联合诊断高于单独sTREM-1、SIRS评分(P＜0.05)。结论 sTREM-1、SIRS评分在烧伤患者并发脓毒症诊断方面具有一定的价值，联合两项指标可提高诊断效能。
- 烧伤 /
- 脓毒症 /
- 可溶性髓样细胞触发受体1 /
- 全身炎症反应综合征评分
Abstract: Objective To explore the changes of serum soluble medullary cell trigger receptor 1 (sTREM-1) and systemic inflammatory response syndrome (SIRS) scores in burn patients, and the diagnostic value of the two indexes in burn patients complicated with sepsis. Methods A total of 193 burn patients admitted to Shandong Provincial Third Hospital from March 2019 to October 2020 were selected, including 65 cases of local infection (local infection group), 38 cases of sepsis (sepsis group), and 90 cases of simple burn (simple burns group). Serum sTREM-1 level was detected and SIRS score was performed. The value of sTREM-1 combined with SIRS score in diagnosing burn complicated sepsis was analyzed by receiver operating characteristic curve (ROC). Results Serum sTREM-1 level [(169.83±31.54) ng/mL, (124.05±24.09) ng/mL, (72.18±11.58) ng/mL] and SIRS score [3.5 (2.0, 4.0) vs, 1.5(1.0, 2.0), 0.5(0, 1.0)] in the sepsis group were higher than those in the local infection group and the Simple burns group (P < 0.05), and serum sTREM-1 level and SIRS score in the local infection group were higher than those in the simple burns group (P < 0.05). Logistic regression analysis showed that high sTREM-1 level (OR=2.003, 95% CI: 1.945-2.135) was a risk factor for sepsis in burn patients (P < 0.05). ROC analysis showed that the AUC of sTREM-1, SIRS score, combined sTREM-1 and SIRS score in the diagnosis of burn patients with sepsis were 0.731, 0.629 and 0.943, respectively, and the combined diagnosis was higher than that of sTREM-1 and SIRS score alone (P < 0.05). Conclusion sTREM-1 and SIRS score have certain value in the diagnosis of sepsis in burn patients, and the combination of the two indexes can improve the diagnostic efficiency.
- Burn /
- Sepsis /
- Soluble myeloid cell triggered receptor 1 /
- Systemic inflammatory response syndrome

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图 1 各指标诊断烧伤患者并发脓毒症的ROC曲线

Figure 1. ROC curve of each index in diagnosing burn patients complicated with sepsis

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表 1 3组烧伤患者基线资料比较

Table 1. Comparison of baseline data of burn patients in 3 groups

组别	例数	年龄(x±s，岁)	性别[例(%)]		烧伤至就诊时间(x±s，h)	致伤原因[例(%)]
组别	例数	年龄(x±s，岁)	男性	女性	烧伤至就诊时间(x±s，h)	电损伤	热压伤	化学烧伤	火焰烧伤
单纯烧伤组	90	48.15±12.31	53(58.89)	37(41.11)	1.65±0.36	42(46.67)	19(21.11)	8(8.89)	21(23.33)
局部感染组	65	48.73±11.96	39(60.00)	26(40.00)	2.05±0.42^c	29(44.62)	14(21.54)	3(4.62)	19(29.23)
脓毒症组	38	49.62±12.17	25(65.79)	13(34.21)	3.11±0.59^c	16(42.11)	9(23.68)	2(5.26)	11(28.95)
统计量		0.198^a	0.549^b		151.670^a	1.998^b
P值		0.821	0.760		＜0.001	0.920

组别	例数	烧伤部位[例(%)]				烧伤面积(x±s，%)		烧伤指数(x±s)
组别	例数	头面部	四肢	躯干		烧伤面积(x±s，%)		烧伤指数(x±s)
单纯烧伤组	90	12(13.33)	52(57.78)		26(28.89)	15.35±4.15		19.25±5.26
局部感染组	65	7(10.77)	31(47.69)		27(41.54)	24.65±6.46^c		29.26±9.98^c
脓毒症组	38	6(15.79)	18(47.37)		14(36.84)	41.24±12.11^c		45.19±9.75^c
统计量		3.243^b				177.788^a		140.018^a
P值		0.518				＜0.001		＜0.001
注：^a为F值，^b为χ²值；与单纯烧伤组比较，^cP＜0.05。

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表 2 3组烧伤患者血清sTREM-1水平、SIRS评分比较

Table 2. Comparison of serum sTREM-1 level and SIRS score in three groups of burn patients

组别	例数	sTREM-1(x±s，ng/mL)	SIRS评分[M(P₂₅, P₇₅)，分]
单纯烧伤组	90	72.18±11.58	0.5(0, 1.0)
局部感染组	65	124.05±24.09^a	1.5(1.0, 2.0)^a
脓毒症组	38	169.83±31.54^ab	3.5(2.0, 4.0)^ab
统计量		306.790^c	26.487^d
P值		＜0.001	＜0.001
注：与单纯烧伤组比较，^aP＜0.05；与局部感染组比较，^bP＜0.05；^c为F值，^d为Z值。

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表 3 烧伤患者并发脓毒症的logistic回归分析

Table 3. Logistic regression analysis of burn patients complicated with sepsis

因素	β	SE	Wald χ²	P值	OR(95% CI)
烧伤至就诊时间	0.265	0.193	1.885	0.606	1.303(0.924~1.407)
烧伤面积	0.312	0.269	1.345	0.913	1.366(0.952~1.456)
烧伤指数	0.632	0.217	8.482	0.003	1.881(1.724~1.937)
sTREM-1	0.695	0.236	8.673	0.001	2.003(1.945~2.135)

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表 4 各指标诊断烧伤患者并发脓毒症的效能

Table 4. Efficacy of each index in diagnosing sepsis in burn patients

指标	AUC	95% CI	灵敏度(%)	特异度(%)	约登指数
sTREM-1	0.731	0.626~0.836	71.05	72.31	0.43
SIRS评分	0.629	0.519~0.739	73.68	50.77	0.24
联合	0.943	0.890~0.996	92.11	93.85	0.86

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