Ferat-Osorio Eduardo, Esquivel-Callejas Noemí, Wong-Baeza Isabel, Aduna-Vicente Rosalía, Arriaga-Pizano Lourdes, Sánchez-Fernández Patricio, Torres-González Rubén, López-Macías Constantino, Isibasi Armando
Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, DF, IMSS, Mexico.
J Surg Res. 2008 Nov;150(1):110-7. doi: 10.1016/j.jss.2007.12.805. Epub 2008 Feb 1.
Inflammation is the response of an organism to tissue injury or infection. It is usually limited to the affected tissue, but sometimes the inflammatory mediators reach the bloodstream and act systemically. A compensatory anti-inflammatory response syndrome, in which expression of major histocompatibility complex class II (MHC-II) molecules are decreased, regulates the resulting systemic inflammatory response syndrome (SIRS). SIRS and compensatory anti-inflammatory response syndrome can lead to the development of sepsis. Triggering receptor expressed on myeloid cells (TREM)-1 has been proposed as a biomarker of the presence of sepsis. In this study, we investigated whether TREM-1 is increased only in septic patients, and not in patients with systemic inflammatory response but no infection. We also looked for a possible correlation between TREM-1 and MHC-II expression levels and the patients' progress.
Fifty-eight surgical patients, 14 septic patients and 50 healthy volunteers, were included in this study. TREM-1 and MHC-II expression on blood monocytes was determined by flow cytometry.
TREM-1 expression was increased in all patients after surgery, and its expression was higher in patients with preexisting SIRS. No association was found with the presence of infection. In septic patients, the increase in TREM-1 expression was transitory. MHC-II expression was decreased in both surgical and septic patients, and this decrease was greater in patients with a worse outcome.
Increased TREM-1 expression on monocytes is associated with both infectious and noninfectious inflammatory processes, and the levels of MHC-II expression is better correlated with the patient outcome.
炎症是机体对组织损伤或感染的反应。它通常局限于受影响的组织，但有时炎症介质会进入血液循环并产生全身作用。一种主要组织相容性复合体II类（MHC-II）分子表达降低的代偿性抗炎反应综合征，可调节由此产生的全身炎症反应综合征（SIRS）。SIRS和代偿性抗炎反应综合征可导致脓毒症的发生。髓系细胞触发受体（TREM）-1已被提出作为脓毒症存在的生物标志物。在本研究中，我们调查了TREM-1是否仅在脓毒症患者中升高，而在有全身炎症反应但无感染的患者中不升高。我们还寻找了TREM-1与MHC-II表达水平之间以及与患者病情进展的可能相关性。
本研究纳入了58例外科手术患者、14例脓毒症患者和50名健康志愿者。通过流式细胞术测定血液单核细胞上的TREM-1和MHC-II表达。
所有手术患者术后TREM-1表达均升高，且在术前已有SIRS的患者中其表达更高。未发现与感染的存在有关联。在脓毒症患者中，TREM-1表达的升高是短暂的。手术患者和脓毒症患者的MHC-II表达均降低，且在预后较差的患者中这种降低更为明显。
单核细胞上TREM-1表达的增加与感染性和非感染性炎症过程均相关，而MHC-II表达水平与患者预后的相关性更好。
