探讨髓系细胞触发受体-1在慢性阻塞性肺疾病急性加重期中的临床应用

目的探讨髓系细胞触发受体-1（triggeringreceptorexpressedonmyeloidcell-1，TREM-1）在慢性阻塞性肺疾病急性加重期（acuteexacerbationofchronicobstructivepulmonarydisease，AECOPD）的临床应用。方法随机抽取在我院门诊或住院部诊治的COPD稳定期患者共40例（n=40），按GOLD（肺功能）分级：轻度5例，中度16例，重度13例，极重度6例。全部患者均于稳定期、急性加重期测定TREM1、降钙素原（PCT），急性加重期行痰细菌培养及痰病毒PCR检查。结果AECOPD患者TREM-1水平均较稳定期升高，PCT阳性，差异具有统计学意义（P〈0．05）。痰细菌培养结果阳性患者TREM-1水平、PCT阳性率较阴性患者均升高，差异具有统计学意义（P〈0．05）。痰病毒PCR结果阳性AECOPD患者血清TREM-1水平、PCT阳性率差异无统计学意义。结论TREM-1在AECOPD中是-个敏感的炎症标志物，可作为早期诊断AECOPD的客观指标。在细菌感染相关的AECOPD患者中TREM-1水平升高，但病毒感染相关者无变化，联合PCT可用于判断细菌感染相关的AECOPD，有利于指导临床抗生素的用药。

Investigating the clinical relevance of TREM-1 and PCT in patients with AECOPD

Objective To investigate the clinical relevance of TREM-1 and PCT in patients with AECOPD. Methods Forty patients with clinically stable COPD were recruited. According to GOLD lung function classification, the severity of COPD was mild in 5 cases, moderate in 16, severe in 13, and extremely severe in 6. The concentrations of TREM-1 and PCT in the serum were measured in all patients both acute exacerbation and stable stage. Pathogen examinations in the sputum culture Were measured in all AECOPD patients. Results The levels of TREM-1and PCT were higher in AECOPD patients （ P〈0.05 ）. The levels of TREM-1 and PCT was higher in AECOPD patients in whom sputum bacterial culture was positive than those with negative culture （ P〈 0.05）, but not in sputum viral culture positive patients. Conclusions TREM-1 is a sensitive inflammation marker for AECOPD, and may be use as objective index for AECOPD judgement. The level of TREM-1 was higher in AECOPD patients with bacterial infection while not in AECOPD patients with viral infection. The combined determination of serum TREM-1 and PCT may help to direct application of antibiotic.