胆总管结石患者血清sTREM-1、CRP和直接胆红素水平变化及其诊断急性重症胆管炎价值研究*

doi:10.3969/j.issn.1672-5069.2026.03.036

摘要/Abstract

摘要： 目的探究血清可溶性髓系细胞触发受体-1(sTREM-1)、C反应蛋白(CRP)、直接胆红素(DBIL)和白蛋白(ALB)联合检测诊断胆总管结石患者发生急性重症胆管炎(ASC)的价值。方法 2019年1月~2023年12月我院诊治的胆总管结石患者201例,依据临床三联征、化验和影像学检查诊断ASC。采用流式荧光发光法检测血清sTREM-1水平,应用多因素二元Logistic回归分析影响ASC发生的因素,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析研究指标诊断ASC的效能。结果在201例胆总管结石患者中,发生ASC者28例(13.9%);ASC组发生结石嵌顿、合并胆囊结石和发生三联征占比均显著高于胆总管结石组(P<0.05);ASC组血清sTREM-1、CRP和DBIL水平分别为(313.7±53.6)pg/mL、(88.5±16.8)mg/L和(44.9±6.5)μmol/L,均显著高于胆总管结石组【分别为(178.9±29.5)pg/mL、(22.0±12.7)mg/L和(34.2±5.4)μmol/L,P<0.05】,而血清ALB水平为(32.9±4.9)g/L,显著低于胆总管结石组【(39.1±5.6)g/L,P<0.05】;多因素Logistic回归分析显示,血清sTREM-1(OR=1.740,95%CI:1.267~2.391)、CRP(OR=1.675,95%CI:1.157~2.426)和DBIL(OR=1.590,95%CI:1.197~2.113)均是胆总管结石患者发生ASC的独立危险因素(P<0.05),而血清ALB(OR=0.768,95%CI:0.629~0.938)是保护因素(P<0.05);ROC分析显示,血清sTREM-1、CRP、DBIL和ALB联合诊断ASC的AUC为0.903(95% CI:0.854～0.940)。结论胆总管结石患者血清sTREM-1、CRP和DBIL水平升高或/和ALB水平降低可帮助诊断ASC的发生,为临床干预提供支持。

关键词: 胆总管结石, 急性重症胆管炎, 可溶性髓系细胞触发受体-1, C反应蛋白, 直接胆红素, 白蛋白, 诊断

Abstract: Objective The aim of this study was to investigate serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), direct bilirubin (DBIL) and albumin (ALB) levels in diagnosing acute severe cholangitis (ASC) in patients with common bile duct stones. Methods 201 patients with common bile duct stones were encountered in our hospital between January 2019 and December 2023, and ASC was diagnosed based on Charcot's triad, clinical tests and imaging manifestation. Serum sTREM-1 level was detected by flow fluorescence luminescence. Multivariate binary Logistic regression analysis was applied to analyze the factors impacting the occurrence of ASC. Receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate diagnostic efficacy. Results Of the 201 patients with common bile duct stones in our series, ASC was found in 28 cases (13.9%); incidences of impacted stone, gallbladder stones and Charcot's triad in ASC group were much higher than in patients without ASC (P<0.05); serum sTREM-1, CRP and DBIL levels were (313.7±53.6)pg/mL, (88.5±16.8)mg/L and (44.9±6.5)μmol/L, all significantly higher than [(178.9±29.5)pg/mL, (22.0±12.7)mg/L and (34.2±5.4)μmol/L, respectively, P<0.05], while serum albumin level was(32.9±4.9)g/L, significantly lower than [(39.1±5.6)g/L,P<0.05] in those without ASC; multivariate Logistic regression analysis showed that serum sTREM-1(OR=1.740,95%CI:1.267-2.391),CRP(OR=1.675,95%CI:1.157-2.426)and DBIL(OR=1.590,95%CI:1.197-2.113) were all the independent risk factors for occurrence of ASC (P<0.05), while serum ALB(OR=0.768,95%CI:0.629-0.938) was the protective one (P<0.05);ROC analysis demonstrated that the AUC was 0.903(95% CI:0.854-0.940), with a good diagnostic performance, when serum sTREM-1 was combined with CRP, DBIL and/or ALB levels. Conclusion Serum sTREM-1, CRP and DBIL levels elevate, and/or serum ALB level decrease in patients with common bile duct stones, which might help diagnose ASC when Charcot's triad appears.

Key words: Common bile duct stones, Acute severe cholangitis, Soluble triggering receptor expressed on myeloid cells-1, C-reactive protein, Direct bilirubin, Albumin, Diagnosis

张靖宇, 王一飞, 马路平. 胆总管结石患者血清sTREM-1、CRP和直接胆红素水平变化及其诊断急性重症胆管炎价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 463-466.

Zhang Jingyu, Wang Yifei, Ma Luping. Serum sTREM-1, CRP and direct bilirubin levels help make diagnosis of acute severe cholangitis in patients with common bile duct stones[J]. Journal of Practical Hepatology, 2026, 29(3): 463-466.

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胆总管结石患者血清sTREM-1、CRP和直接胆红素水平变化及其诊断急性重症胆管炎价值研究^*

Serum sTREM-1, CRP and direct bilirubin levels help make diagnosis of acute severe cholangitis in patients with common bile duct stones

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