摘要 目的 探讨血清降钙素原（PCT）、可溶性髓系细胞触发因子-1(sTREM-1)和D-二聚体对脓毒症预后评估的价值。 方法 收集海口市妇幼保健院收治的96例脓毒症患者，按照28天转归分为生存组（62例）和死亡组（34例），分别检测脓毒症患者第1、3、7天血清PCT、sTREM-1和D-二聚体水平。多因素Logistic回归分析脓毒症患者死亡的危险因素。应用受试者工作特征（ROC）曲线分析血清PCT、sTREM-1和D-二聚体水平预测脓毒症患者死亡的价值。采用Pearson相关法分析脓毒症患者血清PCT与sTREM-1和D-二聚体水平的相关性。 结果 死亡组第1、3、7天血清PCT（μg/L：9.16±3.28 vs. 4.75±1.20, 17.63±6.85 vs. 2.94±1.08, 28.42±13.90 vs. 0.68±0.20）、sTREM-1（ng/L：138.50±27.40 vs. 110.25±24.17，150.26±30.74 vs. 116.30±21.35, 161.82±32.74 vs. 108.47±20.62）和D-二聚体（mg/L：2.30±0.94 vs. 1.82±0.52, 2.92±1.05 vs. 2.06±0.70, 3.84±1.12 vs. 1.193±0.85）水平均明显高于生存组（P＜0.05）。多因素Logistic 回归分析显示,血清PCT（2.417，95%CI1.583～4.830）、sTREM-1（1.722，95%CI 1.193～3.316）和D-二聚体（1.508，95%CI1.046～2.417）水平升高是脓毒症患者死亡的独立危险因素（P＜0.05）。ROC曲线分析显示，第3天血清PCT、sTREM-1和D-二聚体三项联合预测脓毒症患者死亡的曲线下面积最大（0.928，95%CI0.865～0.984），其敏感度和特异度较高（分别为93.0%和88.2%）。相关分析显示，死亡组血清PCT与sTREM-1和D-二聚体水平均呈正相关（r=0.837，P＜0.01； r=0.795，P＜0.01）。 结论 血清PCT、sTREM-1和D-二聚体水平与脓毒症患者的病情严重程度相关，第3天三项联合检测对预测脓毒症患者预后不良具有较高的价值。
王绪松，庞春玉，陈绵平. 血清PCT sTREM-1及D-二聚体水平对脓毒症患者预后评估的价值[J]. 中国急救医学, 2019, 39(10): 949-952.
Wang Xu-song, Pang Chun-yu, Chen Mian-ping. Value of serum levels of PCT, sTREM-1 and D-dimer in evaluating prognosis of sepsis patients. Chinese Journal of Critical Care Medicine, 2019, 39(10): 949-952.
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