Aalto Hannele, Takala Annika, Kautiainen Hannu, Siitonen Sanna, Repo Heikki
Department of Bacteriology and Immunology, The Haartman Institute, University of Helsinki, Finland.
Scand J Infect Dis. 2007;39(6-7):596-603. doi: 10.1080/00365540701199808.
Monocyte membrane CD14 (mCD14) and soluble CD14 (sCD14) both associate with poor outcome in sepsis. Because the value of combined use of the markers is unknown we measured both in patients with severe community acquired infections. The study comprised 142 acutely ill patients with community acquired pneumonia and/or blood culture-positive sepsis. Expression of mCD14 was measured, on admission to hospital, by whole blood flow cytometry and sCD14 by ELISA. There was no significant correlation between mCD14 and sCD14. Patients in the lowest tertile of mCD14 were 9.79 times (95% CI 1.31- >50, p =0.006) more likely to die than patients in the middle/highest tertiles. Survival rates in the highest and middle/lowest tertiles of sCD14 levels were comparable. After stratification by sCD14, patients in the lowest tertile of mCD14 were 14.4 times (95% CI 1.90-39.44) more likely to die than patients in the middle/highest tertiles. A significant positive correlation was detected between C-reactive protein and sCD14 levels, providing evidence that sCD14 may serve as an acute phase reactant. In conclusion, low monocyte mCD14 level, unlike the concurrent sCD14 level, predicts 28-d mortality in patients with community acquired infections.
单核细胞膜CD14（mCD14）和可溶性CD14（sCD14）均与脓毒症预后不良相关。由于这两种标志物联合使用的价值尚不清楚，我们对重症社区获得性感染患者进行了两者的检测。该研究纳入了142例患有社区获得性肺炎和/或血培养阳性脓毒症的急性病患者。入院时，通过全血流式细胞术检测mCD14的表达，通过酶联免疫吸附测定法检测sCD14。mCD14与sCD14之间无显著相关性。mCD14处于最低三分位数的患者死亡可能性是处于中间/最高三分位数患者的9.79倍（95%可信区间1.31->50，p =0.006）。sCD14水平处于最高三分位数与中间/最低三分位数的患者生存率相当。按sCD14分层后，mCD14处于最低三分位数的患者死亡可能性是处于中间/最高三分位数患者的14.4倍（95%可信区间1.90-39.44）。检测到C反应蛋白与sCD14水平之间存在显著正相关关系,这表明sCD14可能作为一种急性期反应物。总之，与同时检测的sCD14水平不同，单核细胞mCD14水平低可预测社区获得性感染患者的28天死亡率。
