2024 年第 8 期 第 0 卷

局部脑氧饱和度联合血清可溶性髓系细胞触发受体2对脓毒症相关性脑病的诊断价值

The value of regional cerebral oxygen saturation combined with serum soluble triggering receptor expressed on myeloid cells 2 in the diagnosis of sepsis-associated encephalopathy

作者：朱昌苗尤绍函何震马秉博

英文作者：Zhu Changmiao You Shaohan He Zhen Ma Bingbo

单位：黑龙江省佳木斯市中心医院重症医学科，佳木斯154002

英文单位：Department of Critical Care Medicine Jiamusi Central Hospital Heilongjiang Province Jiamusi 154002 China

关键词：脓毒症；脓毒症相关性脑病；局部脑氧饱和度；可溶性髓系细胞触发受体2；诊断价值

英文关键词：Sepsis;Sepsis-associatedencephalopathy;Regionalcerebraloxygensaturation;Solubletriggeringreceptorexpressedonmyeloidcells2;Diagnosticvalue

• 摘要：

• 目的 探讨局部脑氧饱和度（rScO2）联合血清可溶性髓系细胞触发受体2（sTREM-2）对脓毒症相关性脑病（SAE）的诊断价值。方法 选取2021年1月至2023年10月黑龙江省佳木斯市中心医院重症监护病房收治的脓毒症患者197例，根据院内是否发生SAE分为SAE组（80例）和非SAE组（117例）。比较2组患者临床资料、rScO2和血清sTREM-2水平。采用Logistic回归方法分析SAE的危险因素；采用受试者工作特征曲线分析rScO2联合血清sTREM-2对SAE的诊断价值。结果 SAE组脓毒性休克比例、序贯器官衰竭评估（SOFA）评分和血乳酸水平均高于非SAE组，心率和呼吸频率均快于非SAE组，差异均有统计学意义（均P＜0.05）。SAE组rScO2低于非SAE组［（0.57±0.11）比（0.67±0.06）］，血清sTREM-2水平高于非SAE组［（25±4）ng/L比（21±4）ng/L］,差异均有统计学意义（t=-7.222、7.869，均P＜0.05）。Logistic回归分析结果显示，脓毒性休克、SOFA评分升高、心率加快、血乳酸升高、sTREM-2升高为SAE的独立危险因素，rScO2升高为独立保护因素（均P＜0.05）。受试者工作特征曲线显示，rScO2、血清sTREM-2、二者联合诊断SAE的约登指数分别为0.454、0.452、0.575，其中二者联合诊断价值最高。结论 rScO2降低和血清sTREM-2水平升高与SAE发生独立相关，rScO2联合血清sTREM-2水平对SAE的诊断价值较高。

• Objective To investigate the value of regional cerebral oxygen saturation (rScO2) combined with serum soluble triggering receptor expressed on myeloid cells 2 (sTREM-2) in the diagnosis of sepsis-associated encephalopathy (SAE). Methods  A total of 197 patients with sepsis admitted to the Intensive Care Unit of Jiamusi Central Hospital, Heilongjiang Province from January 2021 to October 2023 were selected. According to the occurrence of SAE in the hospital, the patients were divided into SAE group (80 cases) and non-SAE group (117 cases). The clinical data, rScO2 and serum sTREM-2 levels were compared between the two groups. Logistic regression method was used to analyze the risk factors of SAE. The receiver operating characteristic curve was used to analyze the diagnostic value of rScO2 combined with serum sTREM-2 for SAE. Results  The proportion of septic shock, sequential organ failure assessment (SOFA) score, and blood lactate level in the SAE group were higher than those in the non-SAE group, and the heart rate and respiratory rate were faster than those in the non-SAE group (all P＜0.05). The rScO2 in SAE group was lower than that in non-SAE group ［(0.57±0.11) vs (0.67±0.06)］, and the serum sTREM-2 level was higher than that in non-SAE group ［(25±4)ng/L vs (21±4)ng/L］（t=-7.222, 7.869, both P＜0.05）. Logistic regression analysis showed that septic shock, increased SOFA score, increased heart rate, increased blood lactic acid, and increased sTREM-2 were independent risk factors for SAE, and increased rScO2 was an independent protective factor (all P＜0.05). The receiver operating characteristic curve showed that the Youden index of rScO2, serum sTREM-2 and their combination were 0.454, 0.452 and 0.575, respectively, and the combination of the two had the highest diagnostic value. Conclusions  Decreased rScO2 and increased serum sTREM-2 level are independently associated with the occurrence of SAE. The combination of rScO2 and serum sTREM-2 level has a high diagnostic value for SAE.