目的 探讨可溶性髓样细胞触发受体-1（sTREM-1）、降钙素原（PCT）与髓系相关蛋白8/14（MRP8/14）对重症肺结核患者继发急性呼吸窘迫综合征（ARDS）的时序预测价值。 方法 采用回顾性队列研究设计，选取2021年1月至2024年12月医院收治的重症肺结核患者作为研究对象，按8∶2的比例将患者随机分为训练集（148例）和验证集（37例）。通过电子病历系统提取患者入院时、入院3 d、入院7 d的sTREM-1、PCT及MRP8/14检测数据，采用多因素logistic回归分析危险因素，并通过ROC曲线评估预测效能。 结果 最终纳入185例重症肺结核患者，其中训练集148例患者中，继发ARDS者27例，未继发ARDS者121例；验证集37例患者中，继发ARDS者7例，未继发ARDS者30例。训练集的两组患者血清sTREM-1、PCT及MRP8/14水平随时间呈现显著变化（P < 0.05）。入院时、入院3 d、入院7 d ARDS组血清sTREM-1、PCT、MRP8/14水平均高于非ARDS组（P < 0.05）。入院时、入院3 d、入院7 d的血清sTREM-1、PCT、MRP8/14水平均是重症肺结核患者继发ARDS的危险因素（P < 0.05）。训练集ROC曲线结果显示，出入院时sTREM-1、PCT水平及MRP8/14联合预测的曲线下面积（AUC）最大为0.976，95%CI为0.952 ~ 1.000，灵敏度为88.9%，特异度为98.3%。验证集ROC曲线结果显示，出入院时sTREM-1、PCT水平及MRP8/14联合预测的AUC最大为0.957，95%CI为0.895 ~ 1.000，灵敏度为100.0%，特异度为86.7%。 结论 sTREM-1、PCT与MRP8/14的水平变化对重症肺结核患者ARDS发生具有时序预测价值，联合检测可提高预警准确性。

Objective To investigate the temporal predictive value of soluble triggering receptor expressed on myeloid cells-1 （sTREM-1）， procalcitonin （PCT）， and myeloid-related protein 8/14 （MRP8/14） for secondary acute respiratory distress syndrome （ARDS） in patients with severe pulmonary tuberculosis. Methods A retrospective cohort study was conducted among patients with severe pulmonary tuberculosis admitted between January 2021 and December 2024. Patients were randomly assigned in an 8∶2 ratio to a training set （n = 148） and a validation set （n = 37）. Serum sTREM-1， PCT， and MRP8/14 were extracted from the electronic medical record at three time points： on admission （day 0）， day 3， and day 7. Multivariable logistic regression was used to identify risk factors， and predictive performance was evaluated using receiver operating characteristic （ROC） curves. Results A total of 185 patients were included. In the training set （n = 148）， 27 developed ARDS and 121 did not； in the validation set （n = 37）， 7 developed ARDS and 30 did not. In the training set， serum sTREM-1， PCT， and MRP8/14 levels showed significant temporal changes （P < 0.05）. At admission， day 3， and day 7， levels of sTREM-1， PCT， and MRP8/14 were higher in the ARDS group than in the non-ARDS group （all P < 0.05）. At each time point， sTREM-1， PCT， and MRP8/14 were independently associated with the development of ARDS （P < 0.05）. In the training set， the combination of sTREM-1， PCT， and MRP8/14 at admission yielded the largest area under the ROC curve ［AUC = 0.976； 95% confidence interval （CI）， 0.952 ~ 1.000］， with a sensitivity of 88.9% and a specificity of 98.3%. In the validation set， the same combination achieved an AUC of 0.957 （95% CI， 0.895 ~ 1.000）， with a sensitivity of 100.0% and a specificity of 86.7%. Conclusion Dynamic changes in sTREM-1， PCT， and MRP8/14 provide temporal predictive value for ARDS in patients with severe pulmonary tuberculosis， and the combined assessment improves early warning accuracy.