Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece.
BMC Infect Dis. 2010 Sep 29;10:286. doi: 10.1186/1471-2334-10-286.
Differential diagnosis of patients with lung infiltrates remains a challenge. Triggering receptor expressed on myeloid cells (TREM)-1 is a neutrophil and monocyte receptor up-regulated during infection. The aim of this study was to evaluate the diagnostic accuracy of TREM-1 and of C-reactive protein (CRP) from patients with lung infiltrates to discern community acquired lung infections.
68 patients admitted to a medical ward with acute respiratory illness were enrolled in the study. Neutrophil and monocyte TREM-1 expression were measured by flow cytometry, sTREM-1 by an enzyme immunoassay and C-reactive protein by nephelometry. Clinical pulmonary infection score was recorded.
34 patients were diagnosed with bacterial community acquired pneumonia (group A) and 34 with non-bacterial pulmonary disease (group B). Median serum TREM-1 concentration was 102.09 pg/ml in group A and lower than 15.10 pg/ml (p < 0.0001) in group B. Mean±SE neutrophil TREM-1 expression was 4.67 ± 0.53 MFI in group A and 2.64 ± 0.25 MFI (p = 0.001) in group B. Monocyte TREM-1 expression was 4.2 ± 0.42 MFI in group A and 2.64 ± 0.35 MFI (p = 0.007) in group B and mean±SE CRP was 18.03 ± 2 mg/ml in group A and 7.1 ± 1.54 mg/ml (p < 0.001) in group B. A cut-off of 19.53 pg/ml of sTREM-1 with sensitivity 82.6% and specificity 63% to discriminate between infectious and non-infectious pulmonary infiltrates was found. sTREM-1 at admission greater than 180 pg/ml was accompanied with unfavourable outcome.
TREM-1 myeloid expression and sTREM-1 are reliable markers of bacterial infection among patients with pulmonary infiltrates; sTREM-1 is a predictor of final outcome.
肺部浸润患者的鉴别诊断仍然是一个挑战。触发受体表达在髓样细胞（TREM）-1 是一种在感染过程中上调的中性粒细胞和单核细胞受体。本研究旨在评估 TREM-1 和 C-反应蛋白（CRP）在肺浸润患者中的诊断准确性，以区分社区获得性肺部感染。
将 68 例因急性呼吸道疾病入住内科病房的患者纳入研究。通过流式细胞术测量中性粒细胞和单核细胞 TREM-1 表达，通过酶联免疫吸附法测定可溶性 TREM-1（sTREM-1），通过比浊法测定 C-反应蛋白。记录临床肺部感染评分。
34 例患者被诊断为细菌性社区获得性肺炎（A 组），34 例为非细菌性肺部疾病（B 组）。A 组血清 TREM-1 浓度中位数为 102.09pg/ml，低于 15.10pg/ml（p<0.0001）。A 组中性粒细胞 TREM-1 表达均值±SE 为 4.67±0.53MFI，B 组为 2.64±0.25MFI（p=0.001）。A 组单核细胞 TREM-1 表达为 4.2±0.42MFI，B 组为 2.64±0.35MFI（p=0.007）。A 组 C 反应蛋白均值±SE 为 18.03±2mg/ml，B 组为 7.1±1.54mg/ml（p<0.001）。发现 sTREM-1 截断值为 19.53pg/ml，敏感性为 82.6%，特异性为 63%，可区分感染性和非感染性肺部浸润。入院时 sTREM-1 大于 180pg/ml 与不良结局相关。
TREM-1 髓样表达和 sTREM-1 是肺部浸润患者细菌感染的可靠标志物；sTREM-1 是预后的预测因子。
