Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Respiration. 2012;83(2):133-9. doi: 10.1159/000328413. Epub 2011 Jun 23.
Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) is an activating receptor on inflammatory cells upregulated by microbial products. Elevated levels of sTREM-1 have been associated with the diagnosis and prognosis of patients with sepsis, severe pneumonia and chronic obstructive pulmonary disease (COPD).
The aim of this study was to define the role of sTREM-1 in acute exacerbations of COPD (AE-COPD) and to investigate the ability of sTREM-1 to differentiate between infectious triggers of AE-COPD.
Smokers without COPD (SM), patients with stable COPD (sCOPD) and patients with AE-COPD were prospectively recruited. sTREM-1 levels were determined by ELISA in serum. Potentially pathogenic bacteria were analyzed by sputum culture, and polymerase chain reaction was used to determine the presence of respiratory viruses.
One hundred and ninety-five subjects were included: 64 sCOPD patients, 118 AE-COPD patients and 13 SM. In 62 (52.6%) AE-COPD patients, a respiratory pathogen was detected. Serum levels of sTREM-1 were barely detectable in SM but were significantly increased in patients with sCOPD [97.5 (interquartile value 76.6) pg/ml] and AE-COPD [110.9 (98.5) pg/ml; p<0.001]. There was no significant difference in sTREM-1 between sCOPD and AE-COPD (p=0.277). However, in AE-COPD, sTREM-1 was significantly lower in patients with virus detection [87.5 (97.3) pg/ml] compared to those without [120.3 (99.7) pg/ml; p=0.015]. No difference was found in AE-COPD patients with or without bacterial detection.
The present study shows an increase in sTREM-1 in patients with COPD compared to SM but not in AE-COPD compared to sCOPD. Viral exacerbations showed significantly lower sTREM-1 levels than non-viral exacerbations.
髓系细胞表达的可溶性触发受体 1（sTREM-1）是一种炎症细胞上的激活受体，其水平可被微生物产物上调。sTREM-1 水平升高与脓毒症、重症肺炎和慢性阻塞性肺疾病（COPD）患者的诊断和预后相关。
本研究旨在确定 sTREM-1 在 COPD 急性加重（AE-COPD）中的作用，并探讨 sTREM-1 区分 AE-COPD 感染诱因的能力。
前瞻性招募无 COPD 的吸烟者（SM）、稳定期 COPD 患者（sCOPD）和 AE-COPD 患者。采用 ELISA 法检测血清 sTREM-1 水平。通过痰培养分析潜在的病原菌，聚合酶链反应检测呼吸道病毒的存在。
共纳入 195 例患者：64 例 sCOPD 患者、118 例 AE-COPD 患者和 13 例 SM。在 62 例（52.6%）AE-COPD 患者中检测到呼吸道病原体。SM 患者血清 sTREM-1 水平几乎检测不到，但 sCOPD 患者[97.5（四分位间距 76.6）pg/ml]和 AE-COPD 患者[110.9（98.5）pg/ml]显著升高（p<0.001）。sCOPD 和 AE-COPD 患者之间 sTREM-1 无显著差异（p=0.277）。然而，在 AE-COPD 患者中，病毒检测阳性患者的 sTREM-1 水平明显低于病毒检测阴性患者[87.5（97.3）pg/ml 比 120.3（99.7）pg/ml；p=0.015]。在 AE-COPD 患者中，无论是否检测到细菌，sTREM-1 均无差异。
本研究显示，与 SM 相比，COPD 患者的 sTREM-1 水平升高，但与 sCOPD 相比，AE-COPD 患者的 sTREM-1 水平无升高。病毒加重组的 sTREM-1 水平明显低于非病毒加重组。
