Bishara Jihad, Goldberg Elad, Ashkenazi Shai, Yuhas Yael, Samra Zmira, Saute Milton, Shaked Hila
Infectious Diseases Unit, Tel Aviv University, Petah-Tiqwa, Israel.
Ann Thorac Surg. 2009 Jan;87(1):251-4. doi: 10.1016/j.athoracsur.2008.09.047.
Studies have shown that soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is upregulated by microbial products in the bronchoalveolar lavage fluid, and cerebrospinal fluid of patients with pneumonia and bacterial meningitis, respectively. Our goal was to evaluate whether sTREM-1 in pleural fluid can distinguish pleural empyema from postthoracotomy-related pleural effusion and effusions of other etiologies.
Patients who presented with pleural effusion were identified through laboratory records. In addition to routine biochemical markers, differential white blood cells, cytology, Gram stain, and pleural fluid culture, pleural fluid sTREM-1 was measured by enzyme-linked immunosorbent assay using a commercial kit (R&D Systems, Minneapolis, MN).
Eighty-nine patients were included in the study: 17 with empyema, 7 simple parapneumonic effusion, 18 transudate, 12 postthoracotomy pleural effusion, 22 malignancy, 1 connective tissue disease, and 12 with undetermined effusion. Mean levels of sTREM-1 were significantly higher in empyema than in postthoracotomy pleural effusion (687 +/- 479 pg/mL vs 34 +/- 81 pg/mL, p < 0.0001, respectively) and in effusions of other etiologies (15 +/- 54 pg/mL, p < 0.0001). A cutoff value of 114 pg/mL for pleural sTREM-1 achieved a sensitivity of 94% and a specificity of 93% in differentiating empyema from pleural effusions of other etiologies. The area under the receiver operating characteristic curve for pleural effusion sTREM-1 as a predictor for empyema was 0.966.
Our findings suggest that sTREM-1 in the pleural fluid can potentially assist clinicians in the differentiation of bacterial from nonbacterial pleural effusion, particularly in postthoracotomy pleural effusion.
研究表明，髓系细胞触发受体-1（sTREM-1）在肺炎患者的支气管肺泡灌洗液以及细菌性脑膜炎患者的脑脊液中分别被微生物产物上调。我们的目标是评估胸腔积液中的sTREM-1能否区分胸膜脓胸与开胸术后相关胸腔积液以及其他病因的胸腔积液。
通过实验室记录确定出现胸腔积液的患者。除了常规生化指标、白细胞分类、细胞学检查、革兰氏染色和胸腔积液培养外，使用商业试剂盒（R&D Systems，明尼阿波利斯，明尼苏达州）通过酶联免疫吸附测定法测量胸腔积液sTREM-1。
89例患者纳入研究：17例为脓胸，7例为单纯类肺炎性胸腔积液，18例为漏出液，12例为开胸术后胸腔积液，22例为恶性肿瘤，1例为结缔组织病，12例胸腔积液病因不明。脓胸患者的sTREM-1平均水平显著高于开胸术后胸腔积液（分别为687±479 pg/mL对34±81 pg/mL，p<0.0001）以及其他病因的胸腔积液（15±54 pg/mL，p<0.0001）。胸腔sTREM-1的截断值为114 pg/mL时，在区分脓胸与其他病因胸腔积液方面的敏感性为94%，特异性为93%。胸腔积液sTREM-1作为脓胸预测指标的受试者工作特征曲线下面积为0.966。
我们的研究结果表明，胸腔积液中的sTREM-1可能有助于临床医生区分细菌性与非细菌性胸腔积液，特别是在开胸术后胸腔积液中。
