血清iNOS、TREM-1、IL-1Ra表达与细菌感染性肠炎患者病情严重程度的关系及其临床意义研究

Relationship between the expression of serum iNOS, TREM-1 and IL-1Ra and the severity of bacterial infectious enteritis and its clinical significance

摘要:

目的 探究细菌感染性肠炎患者血清诱导型一氧化氮合酶（iNOS）、髓样细胞触发受体-1（TREM-1）和白细胞介素-1受体拮抗剂（IL-1Ra）表达的临床意义。方法 前瞻性选取2021年2月—2023年2月广州中医药大学东莞医院收治的120例细菌感染性肠炎患者为研究对象。采集患者粪便标本，分析感染病原菌的病原学特点；根据病情严重程度将患者分为轻度组28例、中度组79例和重度组13例。另选取同期本院体检的健康体检者60例为对照组。比较各组炎症因子［血清降钙素原（PCT）、C反应蛋白（CRP）］、iNOS、TREM-1、IL-1Ra水平；采用Pearson相关分析iNOS、TREM-1、IL-1Ra与炎症因子水平的相关性；采用受试者工作特征（ROC）曲线分析血清iNOS、TREM-1、IL-1Ra对重度细菌感染性肠炎的诊断价值。结果 120例细菌感染性肠炎患者共检出176株病原菌，其中氏阳性菌38株（21.59%），革兰阴性菌138株（78.41%）。4组血清PCT、CRP、iNOS、TREM-1、IL-1Ra水平比较，差异均有统计学意义（P <0.05）；重度组、中度组、轻度组和对照组依次降低（P <0.05）。Pearson相关性分析结果显示，iNOS、TREM-1、IL-1Ra水平与PCT、CRP水平均呈正相关（P <0.05）。ROC曲线分析结果显示，iNOS最佳截断值为50.07 ng/L，诊断重度细菌感染性肠炎的敏感性和特异性分别为76.92%（95% CI：0.462，0.950）、81.31%（95% CI：0.726，0.882）；TREM-1最佳截断值为70.11 pg/mL，诊断的敏感性和特异性分别为84.62%（95% CI：0.546，0.981）、85.05%（95% CI：0.769，0.912）；IL-1Ra最佳截断值为271.75 ng/L，诊断的敏感性和特异性分别为92.31%（95% CI：0.640，0.998）、66.36%（95% CI：0.566，0.752）。结论 细菌感染性肠炎患者血清iNOS、TREM-1、IL-1Ra表达升高，与患者病情严重程度存在相关性；三者在诊断重度细菌感染性肠炎方面具有良好的诊断价值，或可作为临床评估细菌感染性肠炎病情的潜在指标。

关键词:细菌感染性肠炎;诱导型一氧化氮合酶;髓样细胞触发受体-1;IL-1受体拮抗剂;预测价值

Abstract:

Objective To investigate the clinical significance of the expression of serum inducible nitric oxide synthase (iNOS), triggering receptor expressed on myeloid cells 1 (TREM-1) and interleukin-1 receptor antagonist (IL-1Ra) in patients with bacterial infectious enteritis.Methods A total of 120 patients with bacterial infectious enteritis who were admitted to Dongguan Hospital, Guangzhou University of Chinese Medicine from February 2021 to February 2023 were selected as the subjects. Stool specimens were collected to analyze the characteristics of pathogenic bacteria. The patients were divided into mild group (n = 28), moderate group (n = 79) and severe group (n = 13) according to the severity of the disease. At the same time, 60 healthy individuals were selected as the control group. The levels of inflammatory factors [serum procalcitonin (PCT) and C-reactive protein (CRP) ], iNOS, TREM-1 and IL-1Ra in different groups were compared. The correlation between iNOS, TREM-1, IL-1Ra and inflammatory factor levels was analyzed. The diagnostic value of serum iNOS, TREM-1, IL-1Ra in severe bacterial infectious enteritis was analyzed using the receiver operating characteristic (ROC) curve.Results A total of 176 pathogenic bacteria strains were detected in 120 patients with bacterial infectious enteritis, including 38 (21.59%) strains of Gram-positive bacteria and 138 (78.41%) strains of Gram-negative bacteria. Analysis of variance found that there were statistically significant differences in serum PCT, CRP, iNOS, TREM-1 and IL-1Ra among the 4 groups (P < 0.05), and there were statistically significant differences between any two groups (P < 0.05). The levels of above-mentioned indicators decreased in order from the severe group, the moderate group, the mild group, to the control group (P < 0.05). Correlation analysis results showed that the levels of iNOS, TREM-1 and IL-1Ra were positively correlated with the levels of PCT and CRP (P < 0.05). ROC curve analysis showed that the optimal threshold of iNOS was 50.07 ng/L, and its sensitivity and specificity for diagnosing severe bacterial infectious enteritis were 76.92% (95% CI: 0.462, 0.950) and 81.31% (95% CI: 0.726, 0.882). The optimal threshold of TREM-1 was 70.11 pg/mL, and its diagnostic sensitivity and specificity were 84.62% (95% CI: 0.546, 0.981) and 85.05% (95% CI: 0.769, 0.912). The optimal threshold of IL-1Ra was 271.75 ng/L, and its diagnostic sensitivity and specificity were 92.31% (95% CI: 0.640, 0.998) and 66.36% (95% CI: 0.566, 0.752).Conclusion The expression of serum iNOS, TREM-1 and IL-1Ra in patients with bacterial infectious enteritis is elevated, which is correlated with the severity of the disease. The three are helpful for diagnosing severe bacterial infectious enteritis, and may be used as potential indicators for clinical evaluation of the condition of bacterial infectious enteritis.

Key words:bacterial infectious enteritis;inducible nitric oxide synthase;triggering receptor expressed on myeloid cells 1;interleukin-1 receptor antagonist;predictive value