sTREM-1、PCT与MRP8/14对重症肺结核患者急性呼吸窘迫综合征的时序预测价值

doi:10.3969/j.issn.1006-5725.2025.22.012

Abstract

Abstract:

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.

Key words: severe pulmonary tuberculosis, acute respiratory distress syndrome, sTREM-1, procalcitonin, MRP8/14, prediction

CLC Number:

R563.8

Mo DENG,Mishan JIA,Yanqing TIAN,Zhiqing ZHENG,Hui WANG,Na. HAN. Temporal predictive value of sTREM⁃1， PCT， and MRP8/14 for ARDS in severe pulmonary tuberculosis patients[J]. The Journal of Practical Medicine, 2025, 41(22): 3552-3557.

Figures/Tables 8

Tab.1

Tab.2

Tab.3

Analysis of influencing factors for ARDS secondary to pulmonary tuberculosis"

影响因素	B	SE	Wald $χ 2$	P值	OR	95%CI
入院时sTREM-1	0.920	0.114	65.085	< 0.001	2.51	2.007 ~ 3.139
入院时PCT	0.696	0.144	23.524	< 0.001	2.006	1.514 ~ 2.658
入院时MRP8/14	0.416	0.173	5.787	0.016	1.515	1.080 ~ 2.126
入院3 d sTREM-1	0.477	0.113	17.703	< 0.001	1.611	1.290 ~ 2.011
入院3 d PCT	1.039	0.197	27.674	< 0.001	2.825	1.919 ~ 4.160
入院3 d MRP8/14	0.464	0.213	4.767	0.029	1.591	1.049 ~ 2.413
入院7 d sTREM-1	0.341	0.149	5.229	0.022	1.407	1.050 ~ 1.885
入院7 d PCT	0.782	0.245	10.169	0.001	2.186	1.352 ~ 3.536
入院7 d MRP8/14	0.321	0.163	3.888	0.049	1.378	1.002 ~ 1.895
常量	-2.876	0.103	779.698	< 0.001	-	-

Tab.3

Fig.1

Tab.4

Tab.5

Tab.6

Fig.2

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项目	ARDS组（n = 27）	非ARDS组（n = 121）	t/χ² 值	P值
年龄/岁	62.53 ± 8.26	62.49 ± 8.19	0.023	0.982
BMI/（kg/m2）	23.68 ± 3.15	23.42 ± 2.97	0.404	0.686
性别/［例（%）］
男	14（51.85）	70（57.85）	0.322	0.571
女	13（48.15）	51（42.15）
基础疾病/［例（%）］
糖尿病	8（29.63）	29（23.97）	0.399	0.527
高血压	6（22.22）	24（19.83）	0.099	0.753
慢性肺病	5（18.52）	19（15.70）	0.148	0.700
血压/mmHg
收缩压	126.34 ± 11.56	124.45 ± 10.27	0.831	0.407
舒张压	81.15 ± 7.73	80.62 ± 7.84	0.320	0.749
肺结核病程/月	5.12 ± 2.15	5.08 ± 1.92	0.096	0.924
实验室指标
WBC（× 10?·L^-1）	11.81 ± 2.27	11.33 ± 2.04	1.060	0.291
LYM（× 10?·L^-1）	0.48 ± 0.18	0.53 ± 0.22	1.109	0.269

组别	时间	sTREM-1/（pg/mL）	PCT/（ng/mL）	MRP8/14/（ng/mL）
ARDS组（n = 27）	入院时	2.15 ± 0.55^△	5.59 ± 2.25^△	3 120.17 ± 661.33^△
	入院3 d	2.52 ± 0.84^?△	8.32 ± 3.67^?△	2 750.29 ± 606.77^?△
	入院7 d	2.93 ± 1.11^?#△	10.62 ± 1.87^?#△	2 347.14 ± 500.58^?#△
非ARDS组（n = 121）	入院时	1.90 ± 0.52	3.30 ± 0.76	1 588.80 ± 387.74
	入院3 d	1.45 ± 0.49^?	3.06 ± 0.66^?	1 348.77 ± 350.04^?
	入院7 d	1.15 ± 0.37^?#	1.84 ± 0.31^?#	1 156.47 ± 331.70^?

指标	灵敏度/%	特异度/%	约登指数	截断值	AUC	95%CI
入院时sTREM-1	70.4	59.5	0.299	2.015	0.624	0.512 ~ 0.736
入院时PCT	70.4	89.3	0.597	4.110	0.818	0.708 ~ 0.928
入院时MRP8/14	88.9	97.5	0.864	2 468.600	0.962	0.923 ~ 1.000
入院3 d sTREM-1	63.0	95.0	0.58	2.105	0.852	0.767 ~ 0.936
入院3 d PCT	85.2	98.3	0.835	4.470	0.902	0.807 ~ 0.996
入院3 d MRP8/14	88.9	97.5	0.864	2 055.835	0.959	0.912 ~ 1.000
入院7 d sTREM-1	77.8	96.7	0.745	1.835	0.942	0.894 ~ 0.990
入院7 d PCT	92.6	95.0	0.876	2.135	0.938	0.871 ~ 1.000
入院7 d MRP8/14	92.6	92.6	0.852	1 500.560	0.959	0.922 ~ 0.995

指标	灵敏度/%	特异度/%	约登指数	截断值	AUC	95%CI
入院时联合	88.9	98.3	0.872	-	0.976	0.952 ~ 1.000
入院3 d联合	88.9	100.0	0.889	-	0.973	0.941 ~ 1.000
入院7 d联合	92.6	95.9	0.885	-	0.972	0.936 ~ 1.000

指标	灵敏度/%	特异度/%	约登指数	截断值	AUC	95%CI
入院时联合	100.0	86.7	0.867	-	0.957	0.895 ~ 1.000
入院3 d联合	85.7	100.0	0.857	-	0.952	0.856 ~ 1.000
入院7 d联合	85.7	96.7	0.824	-	0.948	0.851 ~ 1.000

Temporal predictive value of sTREM⁃1， PCT， and MRP8/14 for ARDS in severe pulmonary tuberculosis patients

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